2532 STATE ST 2019-07-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 4E77CITY 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 ..fl PROJECT ADDRESS: 2532 STATE ST BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ✓❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: C COMMERCIAL I i "1.-11Y7 kr I 1 /t r (i 1 , et I r..;Y ' ..,. ), .! �.� .-. � � I FIs R?�lt,�IfS.' CONTRACT PRICE OF WORK:$ 2000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: INSTALL 200AMP PANEL AND METER BASE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO E YES-Select Scope: ✓❑ Service ❑ Feeder Circuits-#: 2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom E Thermostat ❑Audio ❑ Secure Access ❑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. E Other(List All): t � NL0A.�q9��AV 'A Mai # kbvisti3rter kA&ek. iVa0Vel F Z4it _ IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: L NO LI 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO EYES-See Below&Pg.3 ❑ Pursuant to RCVV 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, b as. ,- Iu� iyyy I I' S i J 4.-.�tlft�� OWNER NAME: TOM TABACZYNSKI TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2532 STATE ST 1�r' cm, Everett STATE V YA ZIP 98201 OWNER PHONE: 425-248-8999 OWNER EMAIL: TOM.C.TABACZYNSKI@GMAIL.COM CONTRACTOR NAME: Parker BIOS Electric CONTRACTOR ADDRESS: STREET 13630 54th Dr NE ci r Marysville STATE V`�I VA ZIP 98271 CONTRACTOR PHONE: 425-239-6319 CONTRACTOR EMAiL: gary@parkerbroseIectriC.com CONTRACTOR LIC.#(REQUIRED): PARKEBE845NT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):69319HM0918 PRIMARY CONTACT: ❑OWNER ECONTRACTOR OTHER(Please Specify) Sydney for payment and info CONTACT NAME:SYDNEY CONTACT PHONE:360-548-3576 CONTACT EMAIL: admin@parkerbroselectric.com AGREEMENT:!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 t am authorized by the owner of this property to perform the work for which application is made and I comply with the State Co ctors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 4/1/2019 E 0 ner/Authorized t'Cgerdt Signature Date (Revised 1/11/2019) Page 1-Application