1518 CHESTNUT ST 2019-07-16 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: i\Q vV 1 Q S lAt (rt- cV QiV e*q qizo I BUILDING AREA: sq ft PROJECT TYPE: C NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ft SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL,APPLICATION INFORMATION & DESCRIPTION.OF WORT[ ... CONTRACT PRICE OF WORK:$ GJ� ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: hArl9e0-1 WO to IT ote TiArQ afe e/o0,1q ,e, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO El YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio El Secure 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 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 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: ENO EYES-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 i p OWNER NAME: J OE!-1 COA/T t'Vl l/6(i Q 1) ,n TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET �/ '(J/ l/V Ie1✓ l CITY V V V I STATE \AO ZI11 4 ZO OWNER PHONE: ✓ , t/� OWNER EMAIL: " CONTRACTOR NAME: I ntioS- SI CO-1171- CONTRACTOR O.1 C' 1/ CONTRACTOR ADDRESS: STREET /��/y�O('j 17 i I Se Q�/yt� /1 r CITY LR nl v V -r�/�1 STATE �P\ ZIP I"V2- CONTRACTOR PHONE:"IZ✓ 7(00 37,0) CONTRACTORrEMAIL: I V1Ei��"P/YYYI► 1lS Von I • C;/n'Th CONTRACTOR LIC.#(REQUIRED): 11•1 HO t�S 1'✓ Z f1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 014 1 l D Cb PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: S CONTACT PHONE: 4-2_ 3 I� 1`C/I CONTACT EMAIL: S-CA7 r� P 1 n 4/1 Ste/ �jc-tt1(/. (,6WY-N AGREEMENT:I hereby certify that I have read and examined this application and know the same to beltg a 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 wi• he State Contractors Law 1: CW and 296.200 WAC. City of Everett Official Use Only \ PERMIT#: (if. 7 iq E 10 `0G-OL-P-) e n r Auth zed Agent Signature Date / (Revised 1/11/2019) Page 1-Application O / g g