2901 STATE ST 2019-07-24 - Laserfiche WebLink

i ,' ESLCCi(RECAL PERT tlIT APPLICATIION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT, 01 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.0ov I vwvw.everettwa.gov/permits PROJECT SC EIvfOEki ®�r -------"------------1 — -- PROJECT ADDRESS: O(O, (BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCT. )ADDITION 0 TENANT IMPROVMENT 0 REMODEL _ BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU MULTI-FAMILY-#OF UNITS: i 4II COMMERCIAL ELECTRICAL AP 'LIC TEGE1 Qrl ortnamom & DE CittPl O Ota_WORK CONTRACT PRICE OF WORK I 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WI RK: tepotk , F xi ST-1( .1(f '\I I ce, e 11.6LL N 6,0 4_oO ' AAR 9 ' 'J \C,6:- FeA)f,RS cx- 1 4 t BOArtz-D THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) T_il 0 Feeder 0 Circuits-#: I• Complete Re-wire LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: Service LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): Data © Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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): COOS Cif IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: '" 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:,NO DYES-See Below&Pg. 3 j FM Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease 1 ! ' 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. - — CON7•ACT.INFORMAT6ON . OWNER NAME: ,OOP kke p 0 TENANT BUSINESS NAME(If Commercial): , 2a v l S7 OWNER MAILING ADDRESS: STREET #R.1�, � ZIP ` ZC> eNi 21- STATE ' CITY (OWNER PHONE: Z c-C\ ` Fi 1 I OWNER EMAIL: 0 -... M.:..... —�__ 1 CONTRACTOR NAME: XX}tJ‘,...1J2,,k- et '+, --A.C.iltt.- LON(`\�y-O\t ,Ji" CONTRACTOR ADDRESS: STREET 1(�,�,�[1t,e `�}pp.tiK 9O `• . ] __ c�r1Yy� vol- \ . v "-1 NO STATE (lam ---7411e- CONTRACTOR PHONE: -i-j(90 tO— %O (CONTRACTOR EMAIL: b C6 6 o Nt•,),-t CC r C t 10 CONTRACTOR LIC.#(REQUIRED): O NNE C`lOL I--t- CITY OF EVERETT BUSINESS LIC.#(REQUI' 4s PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: '360 `toO ' e -i{0 i_/I `- U 'Bo Iv YJ 6 CL-.. CONTACT EMAIL: z G.-! c:,7,1-_,,U�1L Ppt LI L I:Z. , C cio -L I AGREEMENT:1 hereby certify that I have read 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 r lating construction or the performance of construction. That f am authorized by the owner of this property to perform the work ty for Ewhich tt Official tiapplication is Use made and I comply w the State Co tom Law 18 7 RCW and 296.200 WAC. (PERMIT#: A../ ) A Z �� H .9C)( -t . K Owne t'Adtherized Agent Signature nature fate (Revised 1/11/2019) Page 1-Application