2232 12TH ST 303 2022-10-14 - Laserfiche WebLink

INN EL.CTRICAL PERMIT APPLICA PION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits 2 2 '?j 7 PROJECT SITE INFORMATION PROJECT ADDRESS: 2.822.12th ST#123 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: LAUNDRY CIRCUITS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPL) LINE VOLTAGE WORK? ❑ NO ✓❑YES-Select Scope: ❑ Service ❑ Feeder ✓❑Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Se�c ue"Access ❑ 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. ❑ Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO EYES-See Below& Pg. 3 Pursuant to ROW 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. CONTACT INFORMATION OWNER NAME: CASCADIAN APARTMENTS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2232 12TH ST CITY EVERETT STATE WA ZIP 98201 OWNER PHONE:425.350-5540 OWNER EMAIL: CONTRACTOR NAME: EYLANDER SALES & SERVICE CONTRACTOR ADDRESS: STREET3601 EVERETT AVE cTv EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363 PRIMARY CONTACT: DOWNER DCONTRACTOR ✓❑OTHER(Please Specify) CONTACT NAME:JON QUIET CONTACT PHONE:425.231.2275 CONTACT EMAIL: 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 with the,Stale Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Jill E tcS — a3 Owne ,7t prized Agent Signature Date (Revised 1/11/2019) Page 1-Application