2407 56TH ST SW 2019-08-13 - Laserfiche WebLink

ELECTRICAL PERMIT AP!!.ICATION CITY OF EVERETT PERMIT SE:FffIES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2. C)iS-1411114 & (>rV[ BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ®ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: 3 SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ ILL) ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: DIS t ,P '* , A t cr1-k.?_ C- r -A-�1 c,yLQ_4-, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ) 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. ❑ Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7•NO CI 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. ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 7NO 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. w CONTACT INFORMATION OWNER NAME: T. . Cr _ -'i,� TENANT BUSINESS NAME(If Commercial): OWNER MAILING 11 ADDRESS: STREET 2401} Qp f1 `/ sliti� 9k ,=-__)- v..1,=-__)- v..1V. �1` f� (/� CITY1%1 ' STATE 1'`�A. ZIP t g W OWNER PHONE: • 6• `.-O OWNER EMAIL: r `C� ri:',%'A'493.0'1 o:•,AtPiktS"z "'•i►r:%\l►r.;P.:mow.`;$Terr' CONTRACTOR NAME: f ."Ly1 i-A.€.-kA1 "hint CONTRACTOR ADDRESS: STREET 90 &f313g i��/� CITY '' A—4 S j J LA STATE V V el. ZIP 1 'Z+`,V r h • e CONTRACTOR PHONE:`�j�(�•�'�j��j •��,>C`�(.`.CO TRACTOR EMAIL: )("'ff��,�2�L�(�CONTRACTOR LIC.#(REQUIRED): Tere---"A6-0C&Jj ;->�}—� CITY OF EVERETT_ BUSINESt.LIC.#(REQUIRED):L`--' ��?jC . PRIMARY CONTACT: DOWNER [CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (4,0• ( � c1. OO 41•Q \A. �I.-V-Q.t fwUn CONTACT EMAIL: info e6C�.,24 ,CyANZA�tl ►_c , f__ `yr AGREEMENT:I hereby certify that/have read and examined this application and know the same to be true a d correct. Il 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 performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply \ . wit, e State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: '*kE \q:61 -. l° q Owner/Au. ori te Agent'Signature Date (Revised 1/11/2019) Page 1-Application K______.:.