505 WOOD PL 2019-06-26 - Laserfiche WebLink

ELECTRICAL PERMIT & '-IE ALARM PERMIT APPLICATION k---- Gil-- . -•-= .- - ,: - __- #141P•40. 3200 CEDAR STREET, EVERETT, WA 98201 (P)425257-8810 1 FAX 425-257-8857 1 (E)everetteps(a)everetlwa.gov 1 www,everettwa,govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: 5195- t.)C24:2 Pi., Cue-R-671' 1 L 5%?-c)/ 'PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU N;1 MULTI-FAMII Y-#OF UNITS:!4:, 0 COMMERCIAL BUILDING AREA:_ 41SLOc7(2 Ste_C-1sq ft --- ELECTRICA.‘,APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ c.....„... 41-5.--:---- ASSOCIATED BUILDING PERMIT#(if applicable): q0111 C) ..... IS THIS LOW VOLTAGE WORK? 0 N6-----10 YES-#OF DEVICES: 33 IS THIS A FIRE ALARM PERMIT? 0 NO-17.9 YES-Plans required for review(Both Electrical and Fire Departrn(li Inspect oils are required) --— -- . ----- DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: REPtAce: /P-C ill(Ae-i•-\ •i --rr..r.-• IN)q i/ is)(5,Vs) POOV-ESSA Lt: THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ElBy 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, ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 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 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: SW-el-DAL 2.6•1L 6:STA1t. TENANT BUSINESS NAME If Commercial): 0 i..4 p..P f c, PAR*, AtlTS. OWNER MAILING ADDRESS: STREET 27 c.., 8 4"'U : 1 0 cm, EVE.26"TT STATE IN)4)1 ZiP ciets_-?() ) . . OWNER PHONE: ki 25 ZSZ 5...t1c,(0 OWNER EMAIL: -, - —1 CONTRACTOR NAME: tsi.H rflizi: CONTRACTOR ADDRESS: MAE+T Po scrs 3711 Cf /4.2(...tki c,70 h.) STA IL 1,1QA ZIP lez,-3 - - CONTRACTOR PHONE: 42•S" Zif II NYS-- 1CONTRACTOR EMAIL: . ."-Ef P S. 13/..)/-i saf, .Gorr% CONTRACTOR LIC.CREQUIRED): B tifie..14 9 9 2,-Kt.,) CITY OF EVERETT BUSINESS LIC.#(REQU1RED)i <5.09-7 . . .. PRIMARY CONTACT: 0 OWNER—IN CON TRACTOR 0 OTHER(Please Specify) _ _ ...._...... .„._ CONTACT NAME: CONTACT PHONE: /./ ezi- g q - CP _ re_4-.).5.9: 0 CONTACT EMAIL: -- "'""cp-F A il, — 4. • AGREEMENT:I hereby certify mot I have read and examined this application and know The same to be true and correct. AV provisions of laws and ordinances governing this Oe of win*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 slate or local law regulating construction or the performance aeons/diction, That I em authorized by the owner of this properly to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 2-- - Owner •uthorized Agent Signature Data (Revised 10.'304'018) .F.1 ilk i