3003 W CASINO RD BLDG 40-36 2025-09-26

L ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASH INGTON (P)425-257-8810 1(E)PermitServices@everetriva.gov I vNivi.everettwa.gov/permits PROJECT::SITE INFORMATION .. PROJECT ADDRESS: r 6/a BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLLCATION INFORMATION A,DSCRMPTIOWMWORK CONTRACT PRICE OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: • ' i r iml Cot r !ibt L-_ mc�c i' oyA THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO MYES-Select Scope:{.Service ❑ Feeder ❑ Circuits-#:,24 ❑ Complete Re-wire LOW VOLTAGE WORK? *I NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑ Other(List All): CO.D COIVIPL�ANG z IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO YES See Below&Pg. 2 E] By checking this box, I am stating that I have read and understand all of WAC 296-4613-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: JQNO DYES-See Below&Pg.3 E] Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONVICT INFORMATION;' OWNER NAME: TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET Qo3 O' l • t CITY STATE ZIP 292Q41 WA OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 2 j • M. a CITY 2611 T � STATE WA zIP CONTRACTOR PHONE:20� J`f` 510' 5 CONTRACTOR EMAIL:EX iC X NW CONTRACTOR LIC.#(REQUIRED): 6joTY OF EVERETT BUSINESS LIC.#(REQUIRED): nM PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 20(A . I� �— 1 &"' ►VU n ez 1CONTACT EMAIL: AGREEMENT:I hereby certify that I have read and examined this application and know the same to ft&fte and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 4, lvA,tqh the State Contractors Law 1t3.27 RCW and 296.200 WAC. Cityof Everett Official Use Only PERMIT#: E ,=� o� A Lp I e&Ag n&dknature Date (Revised 41512022) Page 1-Application