2719 12TH ST 2019-07-09 - Laserfiche WebLink

ELECTRICAL 4!RMIT & FIRE ALARM PAMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 '477(P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION 2 71 f sfi PROJECT ADDRESS: 1`� PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT ,REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU iIULTI-FAMILY-#OF UNITS: y 0 COMMERCIAL_ BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$•i /50 C) ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK:( ? I�. �, L'( (/\( Y IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 40 0 YES--See Below&Pg.2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE0 OYES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings or rent,sale,or lease without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. � 1 CONTACT INFORMATION OWNER NAME: —y„Q" C.� TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET `1 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: ^ J�- CONTRACTOR NAME: {) P `jam .Z. ; -.Z. L , CONTRACTOR ADDRESS: STREET L1 7c3-)— ' ok. vAt..t3 1d(i ,c, 2.\J ( /f (1-- CITY STATE �,A. ZIP s =4 1 CONTRACTOR PHONE: Gf?S-g-TG 7y gj CONTRACTOR EMAIL: 'lett L,(LS GD S1'4.-Cee CSC CONTRACTOR LIC.#(REQUIRED):S - -1..._ -T '`-J IGS CITY OF EVERETT BUSINESS LIC.#(REQUIRED J -2)(0 PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: X ® �e CONTACT PHONE: y s--'"S7CP -7....( 15, v°5 /- ��-C/`� CONTACT EMAIL: AN-01/4\)( Q._ g` eic e ( 1 r e ", AGREEMENT:I 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. 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 col ith the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only i 11 /Allikk\A' PERMIT# e k 'c2 - 0 - --- Owne thorized Agent Signa are— Date (Revised 11/5/2018) Page 1-Application