4611 COLBY AVE 2019-08-07 - Laserfiche WebLink

111111111111 EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits g... ..w„PROJECT;SITE-INI RMATIoI PROJEOT ADDRESS: I i ,+1 1c1,f. 4 ifp_ BUILDING AREA: l j (°'1 f sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION fN TENANT IMPROVMENT ❑ REMODEL BUILDING USE; r SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ,.ELECTRICAL A°PLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ .. Z�(�`A) ASSOCIATED BUILDING PERMIT#Of applicable): / DESCRIBE SCOPE OF WORK: �/r ,�,,,cy /�e� 11�i�'v1,�L.�.-�' /f '�lSr /r�. � f e,�. of u. 04.4-01-07/41," 41-.14 ..1-4)61.--(2* THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 1r. NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO [34 YES-#of Devices, SELECT SCOPE(REQUIRED): ❑ Data El Intercom 0. Thermostat ❑Audio El Secure Access El Security System El 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. El Other(List All). COD :C°MPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: K.NO n YES—See Below&Pg.2 7 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 ell of the followin.,sub sections that do not See Page 2 require Plan Review. i El YES YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: $,.0 ❑YES-See Below&Pg. 3 1-1 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on b+ildings 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: . e dr e /4-gcsaat. TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET gJ /5"A t CA")r y fC S TATE LA-JO, z!P 5.1;t `id OWNER PHONE: O 63 T7?t 3, OWNER EMAIL: CONTRACTOR NAME: : ,', • ,�. '. ' ;,k. CONTRACTOR ADDRESS:/ � � +�, "v„ k.1L CITY STATE :.. - 0 3 r:• ZIP CONTRACTOR PHONE:2.O( b CONTRACTOR EMAIL: ._ el07.-‘1,,C;1.-4 (i-4,44.4e r- ' :, f el 5 4 CONTRACTOR LIC.#IREOUIRED): S/Tri d c , r CITY OF EVERETT BUSINESS LIC.#(REQUIRED) F`-'.:;;17:1;;;) CONTRACTOR ['OTHER .... PRIMARY CONTACT: DOWNERHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2 6 i, E/6% 22 , 7: (L r_k _p CONTACT EMAIL: `2 p r �7 r r to "�� C let.L !- l .i GyyY .+ '�.�l�s t AGREEMENT.l hereby ceafify that!have react and examined this application and know the same to be true and correct All irovisions o€!atria end 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 15 27 RCW and 296 200 WAC City of Everett Official Use Only PERMIT/f: +uriHrlA,:Plt.nri7arl Anon**inn sat inn faro iF"havlaott'I,fT'iT�f7•l i79 .- Porto iu.Ann,€ratinr,