11031 19TH AVE SE 2019-08-13 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION ""/„:„=.1 CITY OF EVERETT PERMIT SERVICES -__ - 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PBA.E T'RIMIINFORMA,�!.101il. "; r. PROJECT ADDRESS: 11031 19th Ave SE BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR ❑TOWNHOUSE ❑DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL }? 0 , v eliEN7iRI Allam'AI'P LICA`fFIONIIIli1F,;ORN1 lONl;B (DEMUI I:ONCIEWORI _ CONTRACT PRICE OF WORK:$ 2100 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 2 120C 20 A circuits THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO YES-Select Scope:❑Service ❑ Feeder ❑✓ Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio Cl 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. CIOther(List All):Add circuits IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO El YES—See Below&Pg.2 nf l 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. EYES ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-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. OWNER NAME: T ENANT BUSINESS NAME(If Commercial):Safeway OWNER MAILING ADDRESS: STREET 1OS��ll+ciret `t-Y S �//�'�X/�/��X/ Cn- E\ .- (c STATE l)(J\ft ZIP f V f..i OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: SeaTac Electric, Inc CONTRACTOR ADDRESS: STREET7056 S 220th St cm Kent STATE WA z:a 98032 CONTRACTOR PHONE:253-872-5553 CONTRACTOR EMAIL:frani.schriner@seatacelectric.com CONTRACTOR LIC.#(REQUIRED):SEATAEI077RW CITY OF EVERETT BUSINESS LIC.#(REQUIRED):033037 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-305-0349 Dylon Pyle CONTACT EMAIL: AGREEMENT:/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 la regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I comet h the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /2-6 it R E a - Ogg ner uthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application