7621 BEVERLY LN 2019-06-19 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION OLTCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 ((E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7621 BEVERLY LN, EVERETT, WA 98203 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL.APPLICATION INFORMATION Si DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 3,500 ASSOCIATED BUILDING PERMIT it(if applicable): DESCRIBE SCOPE OF WORK: NEW DISHWASHER - REDUCTION IN LOAD V_LC,0AA,N-et THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑ YES-Select Scope. ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑ Thermostat ❑ 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):KITCHEN EQUIPMENT CODE COMPLIANCE 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO EYES-See Below&Pg. 3 p 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: EVERETT SCHOOL DISTRICT TENANT BUSINESS NAME(If Commercial): EVERGREEN MIDDLE SCHOOL OWNER MAILING ADDRESS: STREET 3900 BROADWAY EVERETT STATE WA ZP 98201 OWNER PHONE:425-385-4000 OWNER EMAIL: CONTRACTOR NAME: CUTTER ELECTRIC CO CONTRACTOR ADDRESS: STREETPO BOX 5789 CITY KENT STATE WA zip 98064 CONTRACTOR PHONE:253-854-1505 CONTRACTOR EMAIL:DONLEY.ZWART@CUTTERELECTRIC.COM CONTRACTOR LIC.#(REQUIREO):CUTTEEL933JS CITY OF EVERETT BUSINESS LIC.#(REQUIRED):45940 PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-854-1505 DON LEY ZWART CONTACT EMAIL:DONLEY.ZWART@CUTTERELECTRIC.COM > AGREEMENT t 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 1 comply ,-'h the State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only PERMIT#: .► ecy? E .AS3 Owner/Authorized Agent S grrature Date (Revised 1/11/2019) Page 1-Application