5003 SUNSET LN 2019-04-17 - Laserfiche WebLink

ELECT- $ L PERMIT APPLICATION 4E77I I OF EVERETT PERMIT SERVICES � CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: ,`jLV'S S/AS C-4 UV BUILDING AREA: iee.:v sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: J SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ Lis tri"/, C) ) ASSOCIATED BUILDING PERMIT#(if applicable): nim DESCRIBE SCOPE OF WORK: 4r14:032_ te+wk T 1oc c. iii-t//ts .t..n/141 1 /IM/14a3 t / L'1 idtrLs THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO NYES-Select Scope:El Service ❑Feeder ❑Circuits-#: 6 ❑Complete Re-wire LOW VOLTAGE WORK? STNO El YES-#of Devices: SELECT SCOPE(REQUIRED):❑Data ❑Intercom ❑Thermostat El 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): , CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 5(1\10 ❑YES—See Below&Pg.2 fl 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:1O EYES-See Below&Pg.3 J pI 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. CONTACT INFORMATION OWNER NAME: }'ei/� 57:141.4--el,.� . TENANT BUSIN SS NAME(If Commercial): OWNER MAILING ADDRESS: STREET (SZ,Z f i.e-'',./ G 4\r ()foie_ f `J _�ry crN .✓er,tt- `� j. STATE r1i/:ems ZIP er › OWNER PHONE: —1 Z-6-• ')'mak' ri r�� OWNER EMAIL: 6j 4.'\ 111 e_3Y�e4 1. C41,iA CONTRACTOR NAME: ( S -p1C CONTRACTOR ADDRESS: STREET p)Zts ifuE iC5r4-1t cev 5.6,1. '`. r( STATE k."1/".� ZIP el'3/ZS CONTRACTOR PHONE:�.�C''Zc� CZ9 '1 ONTRACTOR EMAIL: `,e CC. ie . t ✓tC CO 60/tQ11C.66901 CONTRACTOR LIC.#(REQUIRED): g IZ 1�.1--Aiii., /VpICITY OF EVERETT BUSINESS LIC.#(REQUIRED): SC 1476" PRIMARY CONTACT: DOWNER 64ONTRACTOR ❑OTHER(Please Specify) CONTACTAME: CONTACT PHONE: 706 .3— / t✓ j z4 ' / 3/R TCL—V �L.V l Z CONTACT EMAIL: e.c ,fy ' AGREEMENT:I hereby certify that I have read and examined this application and know the samero be true and correct.All provisions of laW§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 1 comply with the State Contractors Law Law 18.27 W and 296.200 WAC. City of Everett Official Use Only PERMIT#: Owner! horize gnature Date (Revised 1/11/2019) Page 1-Application