1709 74TH ST SE 2019-08-13 - Laserfiche WebLink

ItCIA+ CITY OF EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 ERMIT SERVICES 'Neillgil (P)425 257 8810 I FAX 425 257 885�7a l(E)everetteps@everettwa.gov www.everettwa.gov/Permits M U 1 Y� a s. �� 5... ' I'RI�lg�r s T -�4 C 9Mii , y..,_�,��'�. a,,.. .; .1�. .`wa` `«a�.......�... . .�..�... .,.<. ,_...... ,� ® BUILDING AREA: � 9q q sq ft PROJECT ADDRESS: 1709 711#1S T SE1 EV- y t-H g� l PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI FAMILY #OF UNITS: COMMERCIAL liatOMx ELEC1R`I C A'TION INFORM TtOIS DEER ,\ . ,V... 4 . .. .r (./ CONTRACT PRICE OF WORK:$ 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WO- : Aad ink (2) .e l? �L� AF C i ret-ep h de5 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO iiiLY,=S-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 1 0 Complete Re-wire LOW VOLTAGE WORK? R.NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 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 requiredffor review of device location and installation appro al Other(List All): Aad) 1 V '1- Fhr�e)I4L.( b temcgonymmorinvisvoliowmgwoompo:.. _....r3<a<s 4 _ .uowinewsom -'W IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 0 YES—See Below&Pg.2 11k gr4 By checking this box, I am stating that I have read and understand all of WAC 296-46B-9 , elected the specific reason on page 2 F. of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not t,fly Page 2 require Plan Review. AAE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®NO OYES-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 VI 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 applicatito receive an exemption from this licensing/certification requirement. ..: ARn. '� t - '1,,ry, ``<a ERM `i e �`v�,�c� t.'i'.'.` >i,n .;.�..�. `"..�a., ORNezeggil '� i OWNER NAME: J&r,.e 11 �cc )(-eV. (S1(' NT UUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET /70 7`// ► ✓b � CnY° "Vi !� w (if STATE ZIP / 0 4 03 OWNER PHONE: ziZ 6^3`7'7' i7. Tx OWNER EMAIL: Gulf€ I ,a CONTRACTOR NAME: Se CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: (CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): (CITY OF EVERETT BUSINESS LIC.#(REQUIRED) m PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 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 performance of construction. That I am authorized by the owner of this property to perform the work Citr for r whichvetE Optic ati ion use made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT#: a` �/ I( ed1/ 019) Page 1-Application 9,„,,,,,44.6/Authorized Agent Signaturere ate