1304 MARYLAND AVE 2019-07-24 - Laserfiche WebLink

ELECT RACAL PERMfiT APPUCA1flON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits = = — — PROJECT SITE IN-FORMATION _ 1 -� ll" -- __� _ -1 �PROJECTADDRESS: '- ,i_'l .--17 IL-. ( _ 'BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION LTJ TENANT IMPROVMENT U REMODEL BUILDING USE: 'SFR 0 TOWNHOUSE 0 DUPLEX O ADU U MULTI-FAMILY #OF UNITS: C COMMERCIAL ELECTRICAL APPLICATION INFORMATION,& DESCRIPTION OF_WORK CONTRACT PRICE OF WORK:$ j/' j ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: '',I! t,c cam- C +.w.,Ase_ 00- ��✓u..-v2 c' 1,C{-f:c,.\ l.A P 1 THIS INSTALLATION INCLUDES THE FOLL9WING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: .A.--- ®Complete Re-wire LOW VOLTAGE WORK? italNO ®YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access Uj 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. 0 Other(List All): .......__7.-- ' -----T — CODE C it I1d4PLIANCE �' IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: '�J NO YES--See Below&Pg.2 ro '.1 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: NO 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 U FOREAT1OI , OWNER NAME: ..)etCy ki,e:i TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1OL1 ,,,A`"'y I pvlJ 'µ'RL 1 CITY e-Jc.fZ^1--I- STATE WA. (�ZIP 1 K (OWNER PHONE: (' 2.(-),, ZI 1 I',CV (OWNER EMAIL: CONTRACTOR NAME: (\Aw F le_c_v.L 1:--11L— CONTRACTOR i%1 L-- D CONTRACTOR ADDRESS: STREET I1&(u L V I'�tk Ave_ �� r T. rt'b 101 Q /qQ' c"eae Vie-f"1 • STATE 1/1/Fr- ^qV ZIP D O (CONTRACTOR PHONE: 02 S 3025-4.5 2.l CONTRACTOR EMAIL: MC INj ti-4140 , _..... _ I '60 p�� CONTRACTOR LIC.#(REQUIRED): fkf•t'r_ •Ltd , L i.Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 1(p�1� - 1 (PRIMARY CONTACT: 1 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: < CONTACT PHONE: qqZ 5 2--11 I )r'_ if/ CONTACT EMAIL: area AGREEMENT I hereby certify that I haveveread 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 this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PE® City of Everett Official Use Only I 113 10, o - 1, 1 er/Authorize Agent Signature Date 1 �� (Revised 1/11/2019) Page 1-Application