2201 16TH ST 2019-07-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION / F CITY OF EVERETT PERMIT SERVICES Ie+' 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 .' rAs : ....w PROJECT ADDRESS: 2201 16th St. BUILDING AREA: N/A sq ft PROJECT TYPE: ❑ NEW CONSTRUCTIADDITION El TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL APS`. I$ATION INFORMATION & DES,CRIPTION OF::;WORK CONTRACT PRICE OF WORK:$ $4300.00 ASSOCIATED BUILDING PERMIT#(if applicable): N/A Ali lam{ n3 ,p 1 DESCRIBE SCOPE OF WORK: Install fans, vanity lights, and heain (2 qty) remodeled restrooms. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ✓❑ YES-Select Scope.❑ Service ❑Feeder 0 Circuits-#:5 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El 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. ❑Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACIUTIES: ✓❑NO El 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 El 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:e❑NO OYES-See Below&Pg.3 ❑ Pursuant to RCW 19.25,261,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. >CONTA CTINIFORMATION OWNER NAME: City of Everett TENANT BUSINESS NAME(If commercial):COE-Fire Station#2 OWNER MAILING ADDRESS: STREET 2201 16th St. cm Everett STATE WA _ 98201 OWNER PHONE:(425) 257-8100 OWNER EMAIL:N/A CONTRACTOR NAME: Seahurst Electric CONTRACTOR ADDRESS: sTRE2915 Chestnut St. Cmc Everett STATE V V 1A, A ,98201 CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EmAnAleblanc@seahurst.com CONTRACTOR LIC.#(REQUIRED):SEARUEI099QN ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):18763 PRIMARY CONTACT: CI OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425) 258-5143 Dave LeBlanc CONTACTEMAIL;dleblanc@sehurst.com 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 thds property to perform the work for which application is made and I comply with the Stale Contractors Law 18.27 RCW end 295.200 WAC. City of Everett Official Use Only PERMIT#: *, ...... � '� - (-011" 6-19 ,. Auth �d Agent Signature oat (R �a1/11/2019) Page'I-Application