2112 LOMBARD AVE 2019-03-28 - Laserfiche WebLink

EC CALF_., VERNIT HRH ALAIRkfi PE APFJC = KM CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: I # f Aufl 4i ` I to PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL V--UVhel�1,C�I�U BUILDING USE: FEIFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: sq ft ELECTRICAL,APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ I50O ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑ NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTIONES,'� OF WORK & CODE COMPLIANCE gJ DESCRIPTION OF WORK: Its`� Am C VS51tAi /(�� 05r1-11 91540 DIA e-4 (•1 11191w .I1\Of EITAOY\ THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ® 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. ' CONTACT � INFORMATION OWNER NAME: VtitcliA TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET L/I�rt, CITY 611/ STATE IN/ ZIP 1 OWNER PHONE4/5/41 QJ OWNER EMAIL:e f Y)(� V yV ["[��G� 10‘2,14) I v 1��. CONTRACTOR NAME: f - ' 0(VL-CC-1 C fi�J'C CONTRACTOR ADDRESS: STREET °15921 '2 l a- SE V1' - CITY e V �✓(+ STATE WA- ZIP 1(/2.,( CONTRACTOR PHONE:4E 4)/,)1^ C Ok.0 CONTRACTOR EMAIL: M I i 'ADE l/Vi S TD Iv)•to 01 CONTRACTOR LIC.#(REQUIRED): ,11-0Q OLP 2 V.le CITY OF EVERETT BUSINESS LIC.#(REQUIRED):OLj¶4'l LA PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: \' 5. 9Q7--1,19(71�(7O Nn-f'A`y TAV-�`tV. CONTACT EMAIL: 1Wc (, A nE( A 1 b M,O M 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 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 Only \)/\,". PERMIT# Owner/Authorized Agent Signature Date (Revised 10/30/2018)