2206 HOWARD AVE 2025-11-03 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: /+t/[,17 56- TBUILDING AREA: C-) sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT 11 REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE 11 DUPLEX 11 ADU 13 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL AT LVWrR1dALAPFQ0A1rj'q ....... Fisowpv5N7 CONTRACT PRICE OF WORK:$ a0V 1ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: e 14 h 4-",ez --s- At OF THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? INO 13 YES-Select Scope: 1:1 Service 11 Feeder El Circuits-#: ❑ complete Re-wire LOW VOLTAGE WORK? ONO 11 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): A amn A.. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:A_<LNO U YES See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-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: ONO 19YES-See Below&Pg. 3 El 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. ! 10" 4 0R N M OWNER NAME: '5—A-&'Ly TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: STREET e- CITY STATE ZIP OWNER PHONE: Aj OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: PKOWNER. 0 CONTRACTOR 11 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ;Z7 CONTACT EMAIL: AGREEMENT:/hereby certify that I have read and examined this application and know the same to be true and correct'All p76vigons 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Onl PERMIT M OwftfAuthorized Age t Signature Date' (Revised 41512022) Page 1-Application