2424 BAKER AVE 2019-07-12 - Laserfiche WebLink

05/24/2019 08:53 #4228 P. 001/002 ELECTRICAL PERMIT APPLIATION V R E T T CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 ww8h1NGTON (P)425-257-8810 I FAX 425-257-8857 I(E)evaretteps@everettwe.gov I www.everettwa,gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2424 Baker Ave BUILDING AREA: sq ft PROJECT TYPE: ❑NEIN CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OFOW RK CONTRACT PRICE OF WORK:$ 3000 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ELECTRICAL safety corrections to comply with CiTY OF EVERETT CASE NUMBER: CE19-0348 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT AP f' LINE VOLTAGE WORK? ❑ NO O YES-Select Scope: 0 Service ❑Feeder d Circuits-#:10 11 Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: •SELECT SCOPE(REQUIRED): 0 Data ❑Intercom (D Thermostat ❑Audio `ct❑ Secure • --ss ❑Security System 0 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 ISTHIS HIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO (I YES—See Below&Pg.2 By checking this box,l am stating that I have read and understand all of WAC 29648E-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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: niNO DYES-See Below&Pg.3 ❑ 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/certification requirement, CONTACT INFORMATION OWNER NAME:JAMES W ROTH TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: STREET 1812 2ND.ST CIiY MARYSVILLE STATE WA zir 98270 OWNER PHONE:425.308.3230 • [OWNER EMAIL: CONTRACTOR NAME: EYLANDER SALES&SERIVCE CONTRACTOR ADDRESS: STREET3601 EVERETT AVE cry 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 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: O R!V Y CONTACT PHONE:425.231,2275 CONTACT EMAIL: AGREEME :I hereby certify that I have read and 9YamIned In s a.. :t. and now 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 violata or cancel the provisions of any other state or local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 comet/with th - ate Contractors Law 18.27 RCW and 298.200 WAC. My of Everett Official Use Only PERMIT#: E -o0 2 O, en/ thorized Agent Signature• • 0 r-ate (Revised 1/11/2019) Page 1-Application