3319 COLBY AVE 2019-08-07 - Laserfiche WebLink

' OLT ELECTRICAL PERMIT APPLIGi'ION CITY OF EVERETT PERMIT SERVICES 24'7 „o 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: :JI 9 CpVrj BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU VI MULTI-FAMILY-#OF UNITS: pi COMMERCIAL ELECTRICAL APPLICATION INFORMATION &DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ /55D0 "t' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: C✓,4-Tb/Z up e'Li--L AkI4 "5 i 2 - L(6,1473 •n �'E6W 0-a-c ,s ,tJ n r /-/I/ eri m-L/t e,a(-f-r/r, f=iq do vivic,.r 0IQ z-/� 6.1AtreA)V6iii 4 \-5 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: ®Service V9 Feeder ® Circuits-#: EQ 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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: TO NO 0 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: ONO OYES-See Below&Pg. 3 0 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 OWNER NAME: 5flort:4UL J 4t 7141 TENANT� BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET ,Z 1-01-� 6_71.1-;-y /- i/ -"i %Zc- Q ,/ CITY �G"'�T W r STATE )4 ZIP r e;266, 42-76- ZS Z 64ro OWNER EMAIL OWNER PHONE: CONTRACTOR NAME: G-241-rU,TG C4,,,EL172-fr..2-- Tt-IC- CONTRACTOR ADDRESS: STREET Pt, 0 ,.2 CITY n/g`Gxr STATE 044mew_ ZIP UVr2 ,J CONTRACTOR PHONE: 42- .7 .---,7 44 CONTRACTOR EMAIL: Qyca/1r-fee l�fv''LJ(� ,�,' mea' , Covi,A CONTRACTOR LIC.#(REQUIRED): L gni' i�l Z{�,7 CC- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 2 210 PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4 Zy— X0-- /55D 13, -i- 1--4,730-- 5 CONTACT EMAIL: rgia:l a-re.--<e I trac;.by vici a,_ , 144 AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions o aws 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 r for r which Opic atl ion is made Use Only and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT#: • IV:" 4 ' o E)0 orb_ 10� Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application