6303 ROCKEFELLER AVE 2025-09-30 - Laserfiche WebLink

Fmontghs r property type (Mark only one - If none apply, you may not take out this permit) ngle family residence that is not intended for rent, sale, or lease where I will be living for at least ths after completing electrical work. I will be personally doing the electrical work. 3, or 4 unit residential building, owned by me, that is intended for rent, sale, or lease. I will be one of the units for at least 24 months after completing electrical work. I, personally, and/or a ly employed employee(s) will be doing the electrical work. ace of business, farm or other property: Any new structure that is not intended for rent, sale, or , personally, and/or a regularly employed employee(s) will be doing the electrical work. Existing residential property, place of business or farm. I will not offer the property for sale within 12 months after obtaining the property, and I, personally, and/or a regulary employed employee(s) will be doing the electrical work. ❑ 501(c)(3) or nonprofit religious organization owned property: The total market value of electrical work must be $30,000 or less and all electrical work will be performed by appropriately certified electricians or certified and properly supervised trainees who are volunteering and not being compensated for electrical work per RCW 19.28.091(7). Your signature is required below believe I should be exempt from the requirements to obtain an electrical license or use a certified electrician as provided under RCW 19.28.261. By signing below, I certify the information I am providing on this affidavit is true and accurate. I understand that if I make false statements or misrepresentations I may be assessed penalties. Helen Marie Keller ) 7/14/2021 Printed Name S gnature of Property Owner, Renter, or Lessee Date 3 Property owner and inspection site information Helen Marie Keller Property Owner's Name (Last, First) or Company Name 6303 Rockefeller Avenue Everett WA 98201 Mailing Address Unit/Apt. # City State Zip 425-210-9057 mkeller175@gmail.com Daytime Phone Email Address Inspection site address, if different Unit/Apt. # City State Zip Snohomish Sno Co PUD County Electrical Power Company/ Serving Utility Description of work being done (Example: Adding outlets in the kitchen — second floor break area Upgrading Service box, adding 12 circuits to basement for outlets, lighting, range, refrigerator and washer and dryer Directions to the property L81 will be inspecting From the nearest main street, highway or intersection SE corner of 63rd and Rockefeller Avenue F500-094-000 Property Owner Electrical Work Permit Application 07-2021