2217 JADE AVE 2019-07-24 - Laserfiche WebLink

irj ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2,2I 1 'J(&I4. 1\V( BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION LI ADDITION E I TENANT IMPROVMENT ❑ REMODEL BUILDING USE: CXSFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 'ELECTRICAL APPLIOATIONINFCRMATION..&',DESCRIPTIONVF WORD ' ' CONTRACT PRICE OF WORK:$ I - ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 001-e THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ! YES-Select Scope: YService ❑ Feeder [,(Circuits-#: I ❑Complete Re-wire LOW VOLTAGE WORK? lEX1 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat El Audio ❑Secure Access ❑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 installation approval. ❑ Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 5 NO ❑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: INO 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,iNFORMATIO OWNER NAME: 4/ ' t ( TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1 1 _ CITY -Vee - STATE b'Lr i" ZIP 9.?. 9, 01 OWNER PHONE12-52-5f > L) -7 OWNER EMAIL: CONTRACTOR NAME: P°`i wi-'Y -If.,I .0 Yi C c{{ ' .,s CONTRACTOR ADDRESS: STREET 'AICA(/ f i 2-9 crry -r "oSTATE ZIE' CONTRACTOR PHONE:( �.42I-2A ICONTRACTOR EMAIL: actV- ') + y' 'j}" e(f �/ (i°tic.640,1 CONTRACTOR LIC.#(REQUIRED): r.'NtIC.sZ )- CITY OF EVERETT BUSINE1d'SS LIC.#(REQUIRED): (e(&r b PRIMARY CONTACT: t SWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: 4 CONTACT PHONE: -0)L (Kr ' [° i CONTACT EMAIL: AGREEMENT:I hereby certify that 1 hatie read and examined this application and know the same to be true and cone t. All provisions of laws and ordinances governing this type of work will,beplefed 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 relating 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 comptyW-ith the State Contactors Law 18 Wand 296.200 WAC. City of Everett Official Use Only PERMIT#: Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application