1038 WOODLAWN AVE B 2025-11-03 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 '� WASHINGTON (P)426-257-8810 (E)PermitServices@everettwa.gov I www.everettwa.gov/permit o n i+ 77 i� -1..�*."..."!.-",,.'.,.",'-,.,..'.,.�,�....,-,777 7 FKPJKIPT.3. �jT9100 PROJECTADDRESS: /Ojy sq ft _ 4 C r 31BUILDING AREA: PROJECT TYPE: ONEW CONSTRUCTION OADDITION 11 TENANT IMPROVMENT KREMODEL BUILDING USE: 0 SFR 11 TOWNHOUSE 'DUPLEX 13 ADU 11 MULTI-FAMILY-#OF UNITS: 13 COMMERCIAL APRLICATCON A C r A 11_10 N C -1FT,'10.-1V0F'_.-'T CONTRACT PRICE OF WORK:$ 5�0 JASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Alz.,,v tv br 4. A THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 1-1 YES-Select Scope: 11 Service 13 Feeder 5rCircuits-#: Complete Re-wire LOW VOLTAGE WORK? ❑ NO MYES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data 1:1 Intercom 11 Thermostat ❑Audio ❑ Secure Access ❑ Security System 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is law of device location an I stallatiog approval. IU'Other(List All):_=(, ' 777 777'� 77- 777, IS THIS PE MIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 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 El 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 YES-See Below&Pg. 3 EfPursuant 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. "'COOT -Y AC. OWNER NAME: TENANT BUSINESS NAME(if Commercial): 2 OWNER MAILING ADDRESS: STREET CITY STATE lZ01— ZIP ej OWNER PHONE: 0 OWNER EMAIL: CONTRACTOR NAME: r X CONTRACTOR ADDRESS: STREET N Lip=k�__9 1-�; CITY STATE b CONTRACTOR PHONE: 1CONTRACTOR EMAIL: A CONTRACTOR LIC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.#(REQUI QF E\ILKt 1 PRIMARY CONTACT: VnnE E-5-C-ONTRACTOR IJ OTHER(Please Specify)_ Permit1— CONTACT NAME- 7 CONTACT PHONE: 17_11A_4� I, '* /' (�14— CONTACT EMAIL: e - C-6-79-7 AGREEMENT:I hereby certify that th ve read and examined this application and know the AdAtAll L,,,,,!.,3!ons 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/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 Only PERMIT#: rs E Ownermifth—brizo4gent signature [fate (Revised 41512022) Page 1-Application