1304 BRUSKRUD RD B 2019-06-19 - Laserfiche WebLink

ELECTRICAL ^MIT & FIRE ALARM PORMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 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 477- PROJECT SITE INFORMATION PROJECTADDRESS:1304 Bruskrud Rd unit b103 PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX E ADU 0 MULTI-FAMILY-#OF UNITS.8 ❑ COMMERCIAL BUILDING AREA: 1/8 units aprx 800 sq ft � wr '' ELT ��L APPLICATION INFORMATION Awv v� N CONTRACT PRICE OF WOR '$1000 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WO K? ❑✓ NO ❑YES-#OF DEVICES: y IS THIS A FIRE ALARM PERMIT? El NO E YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Check service is ok to renenergize, water damage due to fire in unit above. IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO 17YES--See Below&Pg.2 Il 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: EINO EYES-See Below& Pg. 3 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: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:Riverton Electrical SAervices, Ilc CONTRACTOR ADDRESS: STREET4116 S 131st st /� CITY Tukwila — �/��A STATE �/ l'h7,2-98-1-617) CONTRACTOR PHONE:206 280-0371 CONTRACTOR EMAIL:WiII C@T riVertOneleCtriCal.COm CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: E OWNER ✓❑CONTF2� ,TOR-- ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206 280-0371 Will G I I I ispie CONTACT EMAIL:will@rivertonelectriCal.com AGREEMENT:I hereby certify that 1 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 authonty 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# ( c WU±L Gi,�+✓iyp-ie, 1/18/2019 ---. _-1 90 — \ Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application