2532 ROCKEFELLER AVE 2019-07-08 - Laserfiche WebLink

IL.ECTRICAL PERMIT APPLIJMTION EVERETT COY Of F.VERUT7 PERMIT SERVICES 3200 Cl [JAR sTRE:F:I,F:vF:RUfl,WA 98201 WASHINGTON (P)42525-/-8810 I FAX 425.251 8851 I(F.)everetteps@everettwa gov I www evercttwa.gov/permits PROJECT°SITE'INFORMATION PROJECT ADDRESS: 2532 Rockefeller Ave BUILDING AREA: sq ft PROJECT TYPE: LI NEW CONSTRUCTION L7 ADDITION n TENANT IMPROVMENT L7 REMODEL BUILDING USE: ,.J SFR [7.71 TOWNHOUSE Li DUPLEX LI ADU LJ MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8''DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Add (1) 20 amp circuit and (5) duplex receptacles on East wall of sanctuary. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO [ YES-Select Scope: ❑ Service ❑ Feeder [7 Circuits-#: 1 El Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO El YES-#of Devices. SELECT SCOPE(REQUIRED): El Data Ll Intercom ❑Thermostat LJ Audio Li Secure Access El Security System n 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. PI Other(List All):.... .. .......... CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: t1 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 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 17INO ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: Itf INO EYES-See Below& Pg. 3W I 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 CO NTAC-fiNfloitIVIATOW OWNER NAME: Calvary Lutheran Church TENANT BUSINESS NAME(If Commercial): Calvary Lutheran Church OWNER MAILING ADDRESS: STREET 2532 Rockefeller Ave clry Everett STATE WA „P 98201 OWNER PHONE:425-252-6775 OWNER EMAIL: CONTRACTOR NAME: E & E Electric, Inc. CONTRACTOR ADDRESS: STREET 23826 35th Ave W CI IV Brier SLATE WA ,p 98036 CONTRACTOR PHONE:425-478-3991 CONTRACTOR EMAIL:eeelectric@comcast.net CONTRACTOR LIC.#(REQUIRED):f:FEl.F_I'981JK CITY OF EVERETT BUSINESS LIC.#(Rt:QUIRt_ ): PRIMARY CONTACT: L}OWNER [✓CONTRACTOR L 1OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425 478 3991 Jay Eggebraaten CONTACT EMAIL:eeelectric@comcast,net ACRFEMFNT.1 hereby certify that I 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 rho 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 with the State Contractors/aw 18 27 RCW and 296 200 WAC. City of Everett Official Use Only PERMIT# Otk 6/6/2019 E Owner/Authorized Ageht ignature Date (Revised 1/11/2019) Page 1-Application