1020 10TH ST 2019-06-05 - Laserfiche WebLink

ECTRICAL PERMIT APPLL.TION f'`� CITY OF EVERETT PERMIT SERVICE sa- 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 1 [Hi d1119 MU RI 1111141111119 €1 _ PROJECT ADDRESS: \Q a-c 1,0)4- rBUILDING AREA: sq ft PROJECT TYPE: C] NEW CONSTRUCTION C.] ADDITION ❑TENANT IMPROVMENTEMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX El ADU C] MULTI-FAMILY-#OF UNITS: COMMERCIAL nonouraunn 11001111111111 OMEN E9 1111 E9 Flinn 11191 d®®/ CONTRACT PRICE OF WORK:$ 'fjali ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 1J S APA 5c.cyl i ? vv i THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? IVO El YES-Select Scope:El Service E] Feeder [-A Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? II1!! 0 I_YES-#of Devices: IImo�,, SELECT SCOPE(REQUIRED): �-I Data El Intercom u Thermostat In Audio 71 Secure Access ❑ Security System El 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): ODOM IMO 1001101111 IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑ 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: ENO EYES-See Below&Pg.3 r(""'"' Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease t 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. 111191®n1 Mann ninflii OWNER NAME: \ r 4- Mt.?"' TENANT BUSINESS NAME(If Commercial): SNel-C" OWNER MAILING ADDRESS: STREET l'Ar -D.A 1\ S1 5AJ q CITY 44 , V a. STATE ,adi ZIP/ S 2 V n OWNER PHONE:!�L - J (, / "°Pe WNER EMAIL:�I j�{' or ft1/F'lt s?NIP Miff, tON CONTRACTOR NAME: VA . 0 ME-6A— -C-1- 7-,1-17;4- C1 CONTRACTOR ADDRESS: STREET °Ir" -�I 1 i4rVE" 1, rr �2•�crrY �� STATE I �*s�,� ZIP CONTRACTOR PHONE: & J1.- 2 LP1O NTRACTOR EMAIL:.304(40 A'()Ti�j'LAS t V M •11CC�Q)V( CONTRACTOR LIC.#(REQUIRED)f t? 0.V.AP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):K 46\ i PRIMARY CONTACT: DOWNER /i+•NTRACTOR ❑OTHER(Please Specify) COII ,� (` tACT NAME: (� S O f�1'( CONTACT PHONE: 7,'41-- O l P JA U t2 `-- ' CONTACT EMAIL: P M ((..4 6 f .6YV'C A A 017W),CAM AGREEMENT:!hereby certify that t 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 l am authorized by the owner of this property to perform the work for which application is made and f comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: �� ►� 21 ` E \ 1- ' \ 0 ner/Aut • ized Agent Signature Dat: (Revised 1/11/2019) Page 1-Application