1513 23RD ST 2019-08-08 - Laserfiche WebLink

1 R ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION 4". . CITY OF EVERETT PERMIT SERVICES K 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 R PROJECT SIT E IINFORMATION a PROJECT ADDRESS: 1513 23rd St Everett,WA 98201 I. I. PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-It OF UNITS: ❑✓ COMMERCIAL 1 BUILDING AREA; ' sq ft? 1 EL,ECTRICAI,.APP ,ICATIION INFORMATIOI CONTRACT PRICE OF WORK: $1000.00 ASSOCIATED BUILDING PERMIT#(If applicable):B1811-016 IS THIS LOW VOLTAGE WORK? Z NO ElYES-#OF DEVICES: j � IS THIS A FIRE ALARM PERMIT? NO El YES-Plans required for review(Both Electrical and Fire Department inspections are required) 1 DESCRIPTION-tOI WORK & CODE::COMPLIANCE _ i DESCRIPTION OF WORK: -panel chance 120/240 volt single phase, 100 amp,-add 3 dedicated circuits, S -add 5 receptacles ii s IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO ❑YES--See Below&Pg.2 ll ll LIBy 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 li of this application(see nextpage),AND Plan Review is NOT required because I meet all of the followingsub sections that do not E Pp q t See Page 2 require Plan Review. 1 ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO DYES-See Below&Pg.3 fPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without Y I I the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and signed the iIIi See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. E! II i; ;:....:`::: C.ONTACT.:INPORMATION:::. .... OWNER NAME: Belle Chang TENANT BUSINESS NAME(If Commercial): MJ Cafe OWNER MAILING ADDRESS: STREET 14725 NE 20th St , CITY Bellevue STATE WA ziP 98007 g OWNER PHONE: OWNER EMAIL: It G CONTRACTOR NAME:Active Engineering '' E. CONTRACTOR ADDRESS: sTREET6605 200th St SW cnv Lynnwood STATE WA zip 98036 1 CONTRACTOR PHONE:425-776-8119 CONTRACTOR EMAIL:bmachovsky@activeengineering.net il CONTRACTOR LIC.#(REQUIRED):Active'o88ms CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 26248 g PRIMARY CONTACT: 12 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) t CONTACT NAME: CONTACT PHONE:425-776-8119 E Bryan Machovsk., g ! CONTACT EMAIL:bmachovsky@activeengineering.net . ( AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ali provisions of laws and ordinances V 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 1 em 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_ 1 0 City of Everett Official Use Only q PERMIT# a i'( I' . E9O \ OO Ili II 0 •ner thorized .gent Signature Dat (Revised 11/5/2018) Page 1-Application t I ii !i