1428 WETMORE AVE 2019-06-25 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.govipermits g PROJECT SIT 11HFORMA IOIN !PROJECT ADDRESS: ?j �t Y� tf' t BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION-tED ADDITION ❑TENANT IMPROVMENT ElREMODEL BUILDING USE: RR u TOWNHOUSE C7 DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS:_ El COMMERCIAL ELECTRICAL APP:U OAT IN * FORMATION &.DESCRIP ON OF WORK R /� tr CONTRACT PRICE OF WORK:$ f V i ASSOCIATED BUILDING PERMIT#(if applicable): p )C)0` -O `°- DESCRIBE SCOPE OF WORK: ' f THIS INSTALLATION INCLUDES TI,FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO ,❑,,YYE�ES-Select Scope:❑Service ❑ Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ !. ' NO YES-#of Devices: El SELECT SCOPE(REQUIRED): CI Data El Intercom Thermostat El Audio Secure Access El 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: a 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 f 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, f�r ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: O DYES-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 application to receive an exemption from this licensing/certification requirement. INFORMATION OWNER NAME: tE C Ci i 66 i\ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET I L4 2.-CZ 'e: -$ `e Y9101—" ( �---p_ ^y errr "e-4 `- STATE +°fit ZIP q ? OWNER PHONE: & Ga -2-1-7 40 OWNER EMAIL: CONTRACTOR NAME: oy r YV) eiNi"{ a- '`)-�- `.'/ d.--Y CONTRACTOR ADDRESS: STREET Li-_7 l /� 2- d 4-14 -, carr (j-4-(-14-1/ STATE 0ziQ ^, CONTRACTOR PHONE:3620?q�q i � CON RACTOR EMAIL: LDV C.t t.. j� )t G/4 i ai)u) CONTRACTOR LIC.#(REQUIRED): r1L2.Ir .jrq aIAi-}"— CITY OF EVERETT BUSINESS LIC.#(REQUIRED): L 9-4-7 PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT Nod s,llk 1�tJ os 'CT PHONE: „ S 64: - t✓ f CONTACT EMAIL: f.1 cryd_S1 t fZ ) �`t,�r l .re AGREEMENT:I hereby certify that l have read and examined this application and know the same to be true end correct. Aft provisions of laws and ordinances governing this type of work wilt be completed whether specified herein or not. The granting of a permit ooes not presume to give authority to violate or cancel the provisions of any other state or focal law regulating construction or the performance of construction. That t 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 ROW and 296.200 WAC. City of Everett Official Use Only - /t PERMIT#: t e lAuthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application