12902 19TH AVE SE 2019-08-13 - Laserfiche WebLink

t _ ___ S-'- .7 S1 X %� c O ` CITY OF EVERETT PERMIT SERVICES 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/ PROJECT SITE INFORMATION _.._. a BUILDING AREA. sq ft PROJECT ADDRESS: I a� 1 � � -� V�. ,k,- .1.(___ �" PROJECT TYPE: 0 NEW CONSTRUCTION U' ADDITION 0 TENANV IMPROVMENT U REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: N.COMMERCIAL ELECTRICAL APPLICATION:INFORMATION ,.DESCRIPTION O WORK , CONTRACT PRICE OF WORK:$ 11 3 3ASSOCIATED BUILDIN PERMIT#(if applicable): N/ DESCRIBE SCOPE OF WORK: p 10.0 C W ( -Pa.t k s WItk IN ' LE 2�wv — .+ .`s !.- I cet Ac LEI\ SitD T I'd reieit?5 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) 4 @�DYES Select Scope: 0 Service 0 Feeder Circuits-#: 0 Complete Re-wire LINE VOLTAGE WORK? ® NO LOW VOLTAGE WORK? till NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat 0 Audio 0 Secure Access 0 Security System 0 Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for rev'ew of device location and installation approval. Of Other(List All): L-I ,ri-rN .. CODE:CON[PLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 0 YES--See Below&Pg.2 ® By checking this box, I am stating that I have read and understand all of WAC 296-46B-90 ,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 I (an Review. ARE Y AN OW PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO ❑YES-See Below&Pg. 3 ® ursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on uildings 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 LE OWNER NAME: LE ►l~& " E -s- TM / U f NESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET P U go(��A /,_17 6/� S CITY S 1'`09 IA4 1 MI6 1^� • STATEVA- ZIP i7 G OWNER PHONE: 14 . ~ J 3� �C41 DOWNER EMAIL IWI ee- ' ?bd' / \A0....6..a v CONTRACTOR NAME: S Olt .9V ,}P.-kc it-i�ly), - G CONTRACTOR ADDRESS: STREET 1 V I e �I- `� 51--. 0_ e \ �./� /� CITY 6--v,CA 1\,eit". -. (STATE `.' �P V I V l�` J CONTRACTOR EMAIL:S Ab�-4 S fI�G ��c— Chu 5 '` eke CONTRACTOR PHONE: i-40` 17 3. �7I p LIC.#(REQUIRED): STARK[_I -1 of R ICITY OF EVERF T BUSINESS LIC.#(REQUI -9) CONTRACTOR .,.....w - PRIMARY CONTACT: 0 OWNERCONTRACTOR 0 OTHER(Please Sppecify) CONTACT AME:�� c CONTACT PHONE: 3-0 C� - 9 3C�q,�' \t' Q �( � S CONTACT EMAIL: SJ ar k� a ��(6):3 e-C 1 i,C e C�0�1'LeG(�j�o J�Q AGREEMENT.•1 hereby.- i that I have read a$d ex- fined this application and know the same to be true nd correct. All provisions of laws and ordinances governing this type of work �I be comp- o.whether specified erei .r not. The granting of a permit does not presume t give authority to violate or cancel the provisions of any other state or I. al la regal ing const .ion or the performana e o .nstruction. That I am authorized by the owner of this property to perform the work for which application is made and I City of Everett Official Use Only c.`ply th State Con•actors Law 18.27 RC I an, '96.200 W C. ' PERMIT#: 'Nik 1 -‘.....-'-. 3.es E ll 0 — 3 ‘ Owner/Aut orized Agent Signa ure Date ' (Revised 1/11/2019) Page 1-Application