610 WINTON AVE 2019-06-26 - Laserfiche WebLink

ELECTRIC 11 ER UT .4PPLK ATION "' CITY OF EVERETT PERMIT SERVICES ��,. 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits :PROJECT SITE;INF.ORivtATlON _" 1....,/,44--i--,---4---PROJECT ADDRESS: (_,0 I D_W V " I I '1--W1 BUILDING AREA. I DO 0 sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT qi REMODEL BUILDING USE: IX SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION:INFORMATIONS:4,:pESCRIPTION Af:WORD , CONTRACT PRICE OF WORK:$ 0 C)0 0 19 - � ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: CI),1.1. 41-12, `'oviit: , THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: Complete Re-wire LOW VOLTAGE WORK? NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio '0 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): CODE:COMPLIANCE: IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I NO 0 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 AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURENO OYES-See Below&Pg. 3 El 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. ::.CONNTACT INEORNMATI.PI • . OWNER NAME: tox.,c, k v.k s" TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET (0 1('0 QSWAD 13 cn�a gf CITY q V9141 1 ›, IN• STATE ZIP 1`, ao it OWNER PHONE L fes" SV1.3 OWNER EMAIL CONTRACTOR NAME: CrbSS'1N t \i c \ C . I CONTRACTOR ADDRESS: STREET j�.Q. -e cr 1 0 CITY FOA--0-if 1I STATE WQ.. ZIP ok,a)`/A CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) 4 SS�e u w (CITY OF EVERETT BUSINESS LIC #(REQUIRED) O 5 O I to 5 PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /t3 i 5 7.----) (0, N/ D y /))Q' r .1,-.11,esS I CONTACT EMAIL: (4 .. Vc.. i A c C,ot•�c.A-( , r ei- EMENT:: hereb certify that 1 have read and examined this application and know the same to be true and correcAll provisions of laws and ordinances governing this p Y typeof 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 wCity ok for Ewhich h eft aepic atil n Use malis ye and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT#: �, \ _ , r. 1ge3— IE'S �O`r/Authorized A nt Signature Date (Revised 1/11/2019) Page 1-Application