1730 BAKER AVE 2019-03-21 - Laserfiche WebLink

JAN-25-2019 15:38 From:Arlington-Electric 360+435+6970 To:4252578857 Page:2/11 ELECTRICAL PERMIT APPLICATION CITE'OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsaaverettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: J'73O &/4//'5 BUILDING AREA: /5-270 ` sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT F„OTEMODEL /Z/eta Sd/4r' BUILDING USE: FR Cl TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELEZER1,CAL' APPLIO STI.ONII,N;I<ORMAT1,O..N ' IDESCRIEVANIV WORK f CONTRACT PRICE OF WORK:S .p.2_5-VC) e-lGG- (ASSOCIATED BUILDING PERMIT#(If applicable): DESCRIBE SCOPE OF WORK: 33 PV • /.2iet.) 9/J THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑YES-Select Scope:ja rvice ❑Feeder ❑Circuits-#: 3 ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom El Thermostat ❑Audio ❑Secure Access . 0 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 dey4 (ce location and installation approval. her(List All): .(/.G✓ 9elcV of, l COD,EEC.MP„,L�`IAN,C,E, `' IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: WO ❑YES-See Below&Pg.2 I I By checking this box, I am stating that I have read and understand all of WAC 295.468-900,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.k O EYES-See Below&Pg.3 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. �^ / C,OI!1zTACT NE RIVIA'TI;ON OWNER NAME: C iri/( p TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 73 i S i' !-19 r� crfY G STATE 14- ZIP�' D� OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: A4/n9/PO aatiste , a CONTRACTOR ADDRESS: STRCET /3?/Q c2YQ Sf A) CRT Aric//yn 10k STATE ZIP 98-2-2 3 CONTRACTOR PHONE: 3/o ,05-bris-- CONTRACTOR EMAIL; L t"///l?4iyj It ( !NS",44Y/1 _ CONTRACTOR LIC.#(REQUIRED):�g 19 NES g 336t IC JCITY OF EVERETT BUSINESS LIC.#(REQUIRED): 32'yU / PRIMARY CONTACT: DOWNER ��. ONTRACTOR ❑OTHER(Please Specify) f CONTACT NAME: CONTACT PHONE: 3O -y6,3 --75 I A_( c.1( (I 1--To CONTACT EMAIL: AGREEMENT,'I hereby certify that I have read and examined this application and know the same to be true 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 pormit 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 le Contractors Law 18. 'r% and 298.200 WAC. CitZ of Everett Official Use Only PERMIT#" f/. * 0\ \-69): OwnerlAuthorlsed Agent Signature Date (Revised 1)11/2019) Page 1-Application