11826 24TH DR SE 2019-08-08 - Laserfiche WebLink

T [CAL PERMIT APPLI• ION CITY OF EVERETT PERMIT SERVICES 4.0°1J—LIA �r 3200 CEDAR STREET,EVERETT,WA 98201 'Ad25(P)425 257 8810 I FAX 425 7 8857 1(E)everruett@everettwa.go((v I www.everettwa.gov/Permits k SSAta .� 4 '. z aa�. "` ,.�.x.,,. x �Y -.::r a91 a �'�..... ,n,\. -..ix, � ..,.,,�r �(eps,..i.... .c.<._�.._ ._�. ... PROJECT ADDRESS: 1 1 8 2—6 2 'F t S t BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI FAMILY #OF UNITS: 0 COMMERCIAL Milkege n ELECTMAL 1#PPLIC T 1100:0 T1044 D..ScU 01CO R te`,... - .._ _,. CONTRACT PRICE OF WORK:$ t'7 n [ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Het- fr-x„. ->!.f, c t ,,c_ ,� r T- THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope: 0 Service 0 Feeder Circuits-#: / 0 Complete Re-wire LOW VOLTAGE WORK? NO 0 YES-#of Devices: / SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio .®Secure Access 0 Security System ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fie Alarm Permit is required` for review of device location and installation approval. Other(List All): r2'7�V/ate/'-G'v�(, t '` fi��'�� ti. ^a te -, a"� x.. ii ANCE ,h ..; C� +,-Y, .. xi.c�"''�'�~w i 4a..._..: ti.,< _,z IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: O ElYES--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: O OYES-See Below&Pg.3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on uil ings 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. �a }:� r°�sv'ax x '"��, ria :� ��.��x�r.,.<` �,� c 1��_� r -.s. ' NMM�_�v� �.<v� OMMaggintata OWNER NAME: rer—tm ///,f s GA /:,-;,G&TENANT BUSINESS NAME(If Commercial): / OWNER MAILING ADDRESS: STREET /J ( ? 0 (7/I- j) SF fy� �j/� CITY C(,ei/ � STATE 1.4.1:/4ZIP q `0 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Q/e,.-6----;G 'n CONTRACTOR ADDRESS: STREET (6 9-O 0-- g-- / G �� ! STATE tn. A ZIP 3-f CITY t- !✓t� � ' CONTRACTOR PHONE: CONTRACTS-4' EMAIL: ( / CONTRACTOR LIC.#(REQUIRED): kr l `? 2. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ? PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) / _ c� CONTACT NAME: CONTACT PHONE: ti 2`S 7L j 9 —7 J Leine 0 LA CONTACT EMAIL: -- 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.-.ormance of construction. That/am authorized by the owner of this property to perform the C work oor whihicht Op c ati application Use Only e is and I comply with the State Contractors L. 18.2 -CW and 296.200 WAC. PERMIT#: c. ....,Y(4/1_12,0„--‘42.__ //A _3/,Owner/Authorized Agent Sig nat d re Date (Revised 1/11/2019) Page 1-Application