3424 W MUKILTEO BLVD 2019-07-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLIATION 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 I www everettwa.gov/permits 046-77 PROJECT SITE INF i[MATION PROJECT ADDRESS: 3424 W Mukilteo Blvd, Everett BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 51 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL EL testi „ APPLICATIO1 1FO1 .,a� ,, RRI 'TIO1 OF WORK ' �. ,,,, CONTRACT PRICE OF WORK:$ 850 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 2 circuits for walk in bath. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO faYES-Select Scope. 0 Service 0 Feeder gCircuits-#2 0 Complete Re-wire LOW VOLTAGE WORK? ...:1 NO 0 YES-#of Devices: SELECT SCOPE(REQUI RED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 Security System 0 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): COIF COMPLIANCE - � ' ...... ',�.,,. 1 :cry, ,,,,,,„,,,,,A IS THIS PERMIT ,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO • YES--See Below&Pg.2 rigBy checking thisEDUCATIONbox, 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: �NO ❑YES-See Below&Pg. 3 1811 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 licensingicertification requirement. 1 CONTACC° INFORMATICI .„>.' 7, OWNER NAME: Diane Davis TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3424 W Mukilteo Blvd, CITY Everett STATE WA ZIP 98203 OWNER PHONE:(949) 887-5218 OWNER EMAIL: CONTRACTOR NAME: Kot Electric LLC CONTRACTOR ADDRESS: STRFET1 51 3 105th Ae Ct E CITY Edgewood STATINA z,P 98372 CONTRACTOR PHONE: (253) 737-7015 CONTRACTOR EMAIL:lonka1992 Q@gmail.com CONTRACTOR LIC.#(REQUIRED):KOTELEL827RC CITY OF EVERETT BUSINESS LIC.#(REQUIRED)e ` PRIMARY CONTACT: 0 OWNER ® CONTRACTOR 0 OTHER(Please Specify) db'Cr-A—)<IdCAD CONTACT NAME: CONTACT PHONE: (253) 737-7015 Leo Kot CONTACT EMAIL: lonka191@gmail.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 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 work for which application is made and I comply will#tate!ontractors L- 8.27. Wand 296.200 WAC. City of Everett Official Use Only PERMIT#: A` -"4 4/23/19 E cOL( 2_09, - OwnerlAut • - •gent Signature Date (Revised-1/11/2019) Page 1-Application