4813 ALPINE DR 2019-07-12 - Laserfiche WebLink

ens ELECTRICAL PERMIT APPLICATION E Y;[E R E T TCITY OF EVERETT PERMIT.SERVICES 3200 CEDAR STREET,EVERETT;:WA 98201 WASH INOTOH (P)425-257-8810;I FAX 425.257.8857 1(E)everetteps@eesrerettwa.gov I wwoeeverettwa.govipetinits. '•,--at �.4 �T ct 4,p PROJE t TT.,...$IN1F RMATIiOir L....1\\:,V14-* V ✓ l•' . < ,. PROJECT ADDRESS: 4813 Alpine DR Everett 98203 BUILDING AREA:, sq ft PROJECT TYPE: ❑:NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 1R1 SFR {0�TOWNHOUSE 0 DUPLEX 0 ADU ■0� MULTI-FAMILY-10 OF UNITS: 0 COMMERCIAL �3., CONTRACT PRICE OF WORK:$ 850 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (3)20 amp circuits THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO Ci YES-Select Scope:0 Service 0 Feeder 0 Circuits4:3 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices:' SELECT SCOPE(REQUIRED):0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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 insta,llation'approval, O Other(List All): 5^ @,i 8 - ` n ,IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ® NO I YES--See'Belbvi'S Pg.;2 0 By checking this box,I am stating that I have read and understand alt of WAC 296.46E-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 OYES-See-Below 8&Pg.3 1 Pursuant to RCW 19.28,261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease i.„„J without the proper electrical licensing and certification,or exemption.By checking this box.I am stating that 1 have completed and See Page 3 signed the AFFIDAVIT on page 3 of:this application to receive an exemption from thix ltcensing(certifi'catign requirement. 1174 a § I IVIS 5 i t +. � �� w.� . a.a...:., �:.....�� 4 ... .r..:�s�..�..� � �.,.•o�(-.��t��, �3:. ._..-- .��a.�,,..xx v�' 'h�"\ 4 ��i+�'w"xft. OWNER NAME:Joan Noel TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: smasr 4813 Alpine DR errr Everett STATE WA zp 98203 OWNER PHONE:na OWNER'EMAIL:na CONTRACTOR NAME: In House Electric CONTRACTOR ADDRESS: STREET1530 117th DR SE', cnv Lake Stevens. sTAlE WA zkp 98258 CONTRACTOR PHONE:4287603203 CONTRACTOR EMAIL:th Ee'®ermits• gmaiicom CONTRACTOR UC.#(REQUIRED):iflhoues952gg CITY OF EVERETT BUSINESS LIC:'#(REQUIRED):044168 PRIMARY CONTACT: DOWNER 11CONTRACTOR OOTHER(Please Specify) CONTACT NAME: f CONTACT PHONE: 4257Ct13203 Kelsey CONTACT EMAIL:iheperrnits@gmail.com AGREEMENT.I herebycertitythat l have read and examined this application and know the same to be true and correct Ali 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 regulatng 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. the Slat:'Contractors t aw 18.2T R 00 WAG. City of Everett Official Use Only 5 PERMIT#: c-. - 0 /6 / E l b(a— c 3 'er/Authorized Agent Sig • ate (Revised VI t/2019) Page 1.ApppticatIen: Scanned with CamScanner