9702 19TH AVE SE 2019-07-25 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 4197-(P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits le'2 PROJECT SITE INFORMATION PROJECT ADDR - -• -10 19th Ave SE PROJECT TYPE: Q EW CONSTRUCTIONADDITION IMPROVMENT REMODEL BUILDING USE: D�SFR I CI TOWNHOUSECl UPLEX U 101VIULTI-FAMILY-*OF UNITS: nn OMMERCIAL w� BUILDING AREA: N/A sq ft , ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$4,100 ASSOCIATED BUILDING PERMIT*(if applicable): IS THIS LOW VOLTAGE WORK? U14O G]YES-*OF DEVICES: IS THIS A FIRE ALARM PERMIT? 0 •Q YES-Plans required for review(Both Electrical and Fire Department inspections are required) N DESCRIPTION OF WORK&CODE COMPLIANCE DESCRIPTION OF WORK: Replace 10 HID pole heads with new LED pole heads THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: EDI 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 EDI 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ® 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 signed the See page g AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Cory Acklus TENANT BUSINESS NAME(if Commercial): Everett Skate Deck OWNER MAILING ADDRESS: STREET 9700 19th Ave SE Cron Everett STATE WA lie 98208 OWNER PHONE: 425-876-4042 'OWNER EMAIL: Cory@everettskatedeck.com CONTRACTOR NAME: Rex Electric Service Inc. CONTRACTOR ADDRESS: STREET 11112 18th ST NE en,. Lake Stevens STATE WA zip 98258 CONTRACTOR PHONE:425-422A 744 1coNTRACTOREMAIL: rriecks@gmail.com 6/t2 423 335' CONTRACTOR UC.*(REQUIRED):REXELES962N4 IcrrY OF EVERETT BUSINESS UC.*(REQUIRED):+ LY.51 LiO\ PRIMARY CONTACT: OWNER WPONTRACTOR @O OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-422-1744 Robin Riecks CONTACT EMAIL: rriecks@gmaii.com AGREEMENT:I 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 regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work fon which application is made and t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT* • Authorized lgnature pate (Revised 1(/30/2018) Page 1 of 3