2827 104TH PL SE 2019-08-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits v � o , .arid i _ .. n ' .. aw PROJECT ADDRESS: • t intrallell BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION C ADDITION ❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE LI DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL�1b>�•h s C ... � ... ,. a... •�`w.i� A�I�� 'tJ `�dA iY� 4a.E 'alRg .l'4"R.��-� .. . aM\`K -C CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: a& IAvAp In THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NOC0-'�`ES=Select Scope: 1=1 Service CI Feeder CI Circuits-#: / ❑Complete Re-wire LOW VOLTAGE WORK? Fl NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El 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. ❑Other(List All): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: in NO • YES--See Below&Pg.2 nI I 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: ENO EYES-See Below&Pg.3 I—I 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: Lel ` "" eck TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4 1 f a ti )-4 (91 sr: p� CITY rLi f STATE tAA . ZIP 91/4.. OWNER PHONE: (OWNER EMAIL: CONTRACTOR NAME: -(Q(Y�S� 5� Ire- ✓ LL�_ CONTRACTOR ADDRESS: STREET ,pc..., r?�aX 4)—' I CITY , (k(1_6 STATE ZIP ' CONTRACTOR PHONE: 1®5 ' g-W-7 CONTRACTOR EMAIL: 'S Sc da-dtet.C. c Lr u' . CD CONTRACTOR LIC.#(REQUIRE. . Cc (iryk • 1CITY OF EVERETT BUSINESS UC.#(REQUIRED): PRIMARY CONTACT: •OWNER ❑CONTRACTOR ❑OTHER(Please Specify) C2)S -3—? CONTACT NAME: CONTACT PHONE: L s-$'-7°3 CONTACT EMAIL: AGREEMENT:!hereby certify that!have ead 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 s.-coed her-in 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 p= ormanc-of construction. That I am authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 1 .27 RC and 296.200 WAC. City of Everett Official Use Only (--; 'PERMI T#' Z ~2-o1 5 Owner/Au orize• •••n `g atu - Date ` (Revised 1/11/2019) ae plication