10011 3RD AVE SE VAPPURO 2019-07-09

ELECTRICAL PERMIT AF;—ICATION �j� —, CITY OF EVERETT PERMIT SCES - 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 PROJECT SITE INFORMATION .PROJECT ADDRESS: / 11/41-),1 f f 7/1 f s F• � BUILDING AREA: k9vi, sqft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: [COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ I. j 0 0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: �01 S``� f' 3 d C � �Ua /p ! Y I `a ee i nn S ,ar-TA.7to. r / ,e�} 1.2t/ / tre oif.5 /r ( efateA e!¢° f:, 20 ! n f fftlaSc. r l.c r THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? �❑l NO ['YES-Select Scope: El Service El Feeder El Circuits-#: 117 Complete Re-wire LI LOW VOLTAGE WORK? NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio El Secure Access El Security System El 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 El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO El YES—See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-468-800,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 UCENSURE: EINO OYES-See Below&Pg_3 ` f 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/cern -•gent. CONTACT INFORMATION OWNER NAME: V V (IfaI) 144 'fes./ /'� TENANT BUSINESS NAME Corn rclal . OWNER MAILING ADDRESS: STREET J f) LI /1 A 1«. Sr CITY EV trcSTATE \......- ` M .. __ ��/ --- - ZIP 4.i�.,,J 11 tJ OWNER PHONE: .Joey I(Q A hie -1y OWNER EMAIL: ,j tiveNvor T/So/a 1','v n.s , C o /1-1 CONTRACTOR NAME: MI) ()le- Sid,Ye^ :: lee i6"; C r 14 G, CONTRACTOR ADDRESS: �` STREET I U 0 /1 3{ #1o,,c, SE 4:4tom, p CITY V!'r e I Wig STATE Ig ZIP 1(I 2-cf"r`r" CONTRACTOR PHONE: 1f) -1_5-7 IrS it 7 CONTRACTOR EMAIL: da_V. 1. Q f r en (f• c 4),41, CONTRACTOR LIC.#(REQUIRED): /e SE 'r1'- ZY2. CITY OF EVERETT BUSINESS UC.#(REQUIRED): k--ko PRIMARY CONTACT: L OWNER Pi CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /1,7_ „_5 s 3 - 4(54. 7 O (i,I PI L(Bift rlfl A t-f - CONTACT EMAIL:jet e1. 5e,G2 F;-,,i 1a<!/'. 6,iv, AGREEMENT:I hereby certify that t 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 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: f r 3- E no(4 _ Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application