5630 BEVERLY LN 2019-03-21 - Laserfiche WebLink

li, ELECTRICAL PERMIT APPLi I N CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 225 257 8857 l(E) .., everetteps@everettwa gov l wwweverettwa.gov/Permits `Syaggga e „ xRGOArSFFM 1yt . S@F. 1W Rdog tXSESX ~ v PROJECT ADDRESS: 56,O '4, LJ.P) ./Y /-- °e- BUILDING AREA: /20 sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT a-REMODEL BUILDING USE: g SFR 0 TOWNHOUSE 0 DUPLEX 0ADU 0 MULTI-FAMILY #OF UNITS: 0 COMMERCIAL 3N � Pr141 110EP TOSICII R . . CONTRACT PRICE OF WORK:$ $ , Ca (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: /,44K ..S',2.Qr/se.e ,Pa-t I THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 'YES-Select Scope:JaService 0 Feeder 0 Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio .0 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 device location and installation approval. ®Other(List All): rnr * '�`j� - ^.a z,, - �`` :05 i. ftMWIFAMO WFSW �..-`"�. :M".* a `U M ca' "'vim' ..; IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: laNO d 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 OYES-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. I sXPRIO µ OREMk RYMLP ,, MONMI NSINhIMMOx " X S OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: , m . .. .;.. . CONTRACTOR NAME: et 1fP_( to i Tie/ G :TN C CONTRACTOR ADDRESS:j5T 4907 6 71' ,5 r 5 Rio T3 fhethITla.l�..- -r PetcAre__ (Ala— • STATE CONTRACTOR PHONE: 091 ?i Li 75S 'CONTRACTOR EMAIL: C t—T P14 6` co ivt Co...r,(-4-417- CONTRACTOR LIC.#(REQUIRED)/1 / i et,z0 ttJej CITY OF EVERETT BUSINESS LIC.#(REQUIRED) PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 'l CONTACT NAME: CONTACT PHONE: L�lz, 35 3 „28$3/7.2 S a is 7/00 ,4 n n O t o on / I CONTACT EMAIL: d0/4'e'-- / ) AGREEMENT:I hereby fk certify that 1 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 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 r for Ewhictt Oh pic licaati ion Use made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. CitPERMIT#: ..... E(0 01- Yr I (Revised 1/11/2019) Page 1-Application caner/Authorized Agent Signature Date