|
031'25;'2019 08 : 42 #4099 P. 001/001
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> vtiA J , 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everettcpsPeverettwa.gov I www.everettwa.gov/permits
<br /> ,,.;. 71,1, ni VOTVAgi*^'i' ' a.• Jw.e ;. 1 . FR3 sr;rg,Fh7ziCx gMX'X:;`. YL,kl' .` m.XrF%?.F,Tfa-^l
<br /> PROJECT ADDRESS: 1 ALVERSON BLVD 3/9 ,.y WYSoj &V0 [BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: Q SFR 0 TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> -IFC-,..ry,.�. ..�•'"' ;1 al� y .; i. '„3'-`�-(-' -re-r^ .✓- •y e'.r.:�'u,"V•
<br /> ..1'. `,-_�"�"rrw...".... y i7 :Tfq p , • :„�
<br /> ��{{ ,,��((tt ,� M 1 y� r u t r ... � i, Y J :��. Y 4 RJ't a�. d y�
<br /> f1.„�.�,dxF,'�,�,7lwA.4�T[1X,M1JA4, �bl ��;-- W� �u u �' � �� � .. N.S:'CPCiJCnI.V'rl�b ..�.! 1 C•
<br /> 'H
<br /> 1r.
<br /> CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> CIRCUIT FOR MICROHOOD —
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO R]YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data El Intercom El Thermostat ❑Audio ❑Secure Access ❑ Security System
<br /> LI Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval,
<br /> ❑Other(List All): -
<br /> .. •>:,�Y. rU `. Ir T,•''7 d , ;A; +,a1 T�: !F ihl;.e+K 1:, _,y..,..t �,.i.�Y. ... h• 44 1 ,r *,1 i:a, r� xhp".
<br /> �!:t,4; ,•7�d ., . ..� i ..zlrreap, ., ,b, w - 9 f'D '+ iAr� p, '�'. a �, �, ,
<br /> a �. � . R,u.• . �.�,was,,�„>, ;a� .,.,:�� _s,., .,_,,,,�:
<br /> 13 THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO El YES—See Below& Pg.2
<br /> By checking this box,I am stating that I have read and understand all of WAC 286-46B-900,selected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ZNO EYES-Sao Below&Pg.3
<br /> (n.J
<br /> Pursuant to RCW 19,28-261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> 1 without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> rKi”. 'a •t°2n•.'-h 7..:• ,L ,, aY, 1;r° . ..'&,.; '"r�, '`•`'. Y7 °r'' r n ,F,k a`XV4 �t.• iZ :g ry ,i !'1074 - i gr A,;, het'PA.,;
<br /> OWNER NAME:ALICE ROY TENANT BUSINESS NAMJIf Commercial):
<br /> OWNER MAILING ADDRESS: SIR FET 301 ALVERSON BLVD
<br /> c,r, EVERETT STATE WA Zip 98201
<br /> OWNER PHONE:310.490-5046 OWNER EMAIL;
<br /> CONTRACTOR NAME; EYLANDER SALES & SERVICE
<br /> CONTRACTOR ADDRESS: STREFT 3601 EVERETT AVE
<br /> CITY EVERETT
<br /> STATE �'•W
<br /> A op 98201
<br /> CONTRACTOR PHONE:425-259.2161 (CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED):EYLANSS1421_P IciTy OF EVERETT BUSINESS LIC.#(REQUIRED):016363
<br /> PRIMARY CONTACT; DOWNER ✓❑CONTRACTOR EIOTHER(Please Specify)
<br /> CONTACT NAME:JOHN 2 B O CONTACT PHONE:425.231.2275
<br /> CONTACT EMAIL:
<br /> A6RI±EMEN7`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
<br /> type of work will be completed whether spelled 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
<br /> local law regulating construction or the performance of construction. That I em authorized by the owner of this property to perform the work for which application is made and I
<br /> comply withfhe f. :Contractors t aw 18.27 RCW and 29&200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> Oat
<br /> 0Iuthor'azed Agent Signature (Revised 9/99/2019) Page 1-Application
<br />
|