7422 BEVERLY BLVD 2019-03-21 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION �'�'� CITY OF EVERETT PERMIT SERVICES = 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJEOINitrev: O. T R , PROJECT ADDRESS: 7422 Beverly Blvd BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: _ ❑COMMERCIAL ELECTRICAL,-APRLICATNON INS.ORMATI'QMCD SCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: removing and replacing damaged knob and tube circuit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APP,, - --� � ` LINE VOLTAGE WORK? CINO ElYES-Select Scope: IllService CI Feed: Circuits-#: 1 ,L CI Complete Re-wire LOW VOLTAGE WORK? ❑NO 1]YES-#of Devices: 1t�9 '�� 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): M iryt P y IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ICI NO ❑YES--See Below 8,Pg.2 l�l 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: ENO 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 Pago 3 signed the AFFIDAVIT on page 3 of this applicationto receive an exemption from this licensing/certification requirement. on�}} OWNER NAME: Doris Moran TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7422 Beverly Ln CITY Everett STATE WA ZIP 98203 OWNER PHONE: 425-265-0345 OWNER EMAIL: dmrm22@yahoo.com CONTRACTOR NAME: Parker Bros Electric CONTRACTOR ADDRESS: STREET 13630 54th Dr NE oily Marysville STATE WA Z,P 98271 - CONTRACTOR PHONE: 425-239-6319 CONTRACTOR EMAIL: gary@parkerbroselectric.com .— CONTRACTOR LIC.#(REQUIRED): PARKEBE845NT CITY OF EVERETT BUSINESS LIC.#(REQUIR D):6931189-343=, PRIMARY CONTACT: ❑OWNER !CONTRACTOR ✓❑OTHER(Please Specify) Natalie for payment and info CONTACT NAME: CONTACT PHONE: 360-572-0108 Natalie CONTACT EMAIL: admin@parkerbroselectric.com AGREEMENT:I hereby certify that I have read and oxamined this application and know the same to be true and correct. Alt 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 I comply with the State o ractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: (r) -------- 3/7/2019E �.K . wner/Aut orized g nt Signature Date (Revised 1/11/2019) Page 1-Application