5034 CREST LN 2019-06-24 - Laserfiche WebLink

sli ELECTRICAL PERMIT APPLIWION 0"111111P--- 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 .:' .� a,M �: 5,� a Z .:xh a�b 7 =PD O CT PO $AM �`� �Y. t. �s '.::.t..a.a�yi .. '�?�: ��....._..� ..�,..�.<.. � "., k Z� �',n v1., .Sy � K ..,..�:i. ..........�-s rsa..laa T+ ..a.. . d....V .a....x. PROJECT ADDRESS: <j n 3 - r IlES r L-4 J E (BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 96® 'ENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: 0 COMMERCIAL ONSOM +Mli IMPIl tr AI APMCMON 1 .., .>. M �` ICIXE� ` t ., R..., . M.. .-- _ .._... ..�_. Its [o1FA� � �� .��. ' , CONTRACT PRICE OF WORK:$, / 5-0 o 0- (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: t See/1c— ciA►vtp A1vltrv1 Wiite.A_ THIS INSTALLATION INCLUDES THE FOLLOyING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO trYES-Select Scope:0 Service 0 Feeder 0 Circuits-#: ? 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio Secure Access 0 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)MAI + /a < *n l -y:.. iK 3 sv y `'L v a > OV PAMME zYa�•`W N "'' ,t. �+ , ,;r Iz�TM.'.h '.`i,�,��rN-�'�,' - IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO O 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 OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO OYES-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 See Page 3 signed the AFFIDAVIT on page 3 of this i application to receive an exemption from this licensing/certification requirement. 'fir- r 't.a d #+"` ti�y2c\`ui•M x 6s +e,§+ t k"i� s�1)(co r tf� ,T MI7wtz W..''T�es.. �z"`�e�F•s°. ,cn„. .. A•M. : .M OWNER NAME: G,1I(ls 'e- /40-k)kiet50N.) TENANTLBUSINESS � (NAME(If Commercial): OWNER MAILING ADDRESS: STREET Sd 341 C-� /e-s T L 1 /J£- tS .1--1— STATE 1A)14-k ZIP , Z O ✓ CITY �(�''P��'L � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: FAC-) I I T ! 'e. S L e n'I CONTRACTOR ADDRESS: STREET 7 5-6--1 - /v E 20'`N� Woe- CITY /` e K.✓I^e STATE A- ZIP q re) O 0est yr LS • Pt 4 z. P 23 e 9tviM l t f CUA CONTRACTOR PHONE: 425'; .5-0.5-:: 3Sy�CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): +C,ji, .i ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): S _ PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 44 2 S� 5--0 3 cY V / �J Tev.vt�s `-(, C CONTACT EMAIL: 7)eovi ) j , Pt ei,L.L e_ 23 ��'s�/��, G ri4 W /. cd) ` ��/C this application and know the same to be true and correct. All provisions of laws and o?�nanE s governing this ste or t AGREEMENT:will I bherebycompleted certify that 1 have spread and examined pp type of work be 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 local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the C r�°f r whicht Opic licaati ion Use made and I comply with the State Contractors Law 18.27 d 296.200 WAC. ty PERMIT#: IE \ 00(.d9\ 1 Q1/4......„,_ Date (Revised 1/11/2019) Page 1-Application Owner/Authorized Agent Signature