913 33RD ST B 2022-05-19 - Laserfiche WebLink

/" ELECTRICAL PERMIT APPLICATION /' CITY OF EVERETT PERMIT SERVICES IERETT3200 CEDAR STREET,EVERETT,WA 98201 'WASHINGTON (P)425-257-8810 ( FAX 425-257-8857 j(E)everetteps@everettwa.gov( vmw.everettwa.govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: 913 33RD ST 13 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ®TENANT IMPROVMENT El REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK ' CONTRACT PRICE OF WORK:$ 1500 ASSOCIATED BUILDING PERMIT#(if applicable): 'DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR GRINDER PUMP THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? E]NO ❑YES-Select Scope:❑ Service El Feeder El Circuits-#: III Complete Re-wire LOW VOLTAGE WORK? ❑NO [.71 YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑Intercom El Thermostat ❑Audio El Secure Access ❑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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO El 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. rr�-� !ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:LINO DYES-See Below&Pg.3 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: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ROB'S ELECTRIC INC CONTRACTOR ADDRESS: sTREET4405 103RD AVE SE cin LAKE STEVENS STATE:WA ZIP 98258 CONTRACTOR PHONE:425-334-6834 CONTRACTOR EMAIL:MICHELLE a7ROBSELECTRICINC.COM CONTRACTOR LIC.#(REQUIRED): ?t> E,J.4. do CITY OF EVERETT BUSINESS LIC.#(REQUIRED): £92.5 j 45 PRIMARY CONTACT: '❑OWNER ✓!CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:f hereby certify that I have mad 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 greeting of a permit does hot 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 am authorized by the owner cf this property to perform the work for which application is made and comply with the State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only PERMIT#: -)q EI '1 D5- l 1 Owner/Authorized Agent Signature Date (Revised V/112019) Page 1-Application