710 106TH PL SE 2019-08-14 - Laserfiche WebLink

0.11IP ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (13)425-257-8810 I FAX 425-257-81357 (E)avaretteps@everattwa.gov jwv,m.eveTreltwagoviperrnits PR-041Egr ITE INFORMATION PROJECT ADDRESS: 19D 1134.1114 Pt- %,E BUILDING AREA: sqft PROJECT TYPE: El NEW CONS1RUCTION El ADDITION El TENANT 1MPROVMENT [ REMODEL BUILDING USE: RI SFR El TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: COMMERCIAL '••'1‘tACOLECTR4Kr. LAP":.14. CONTRACT PRICE OF WORK:S ASSOCIATED BUILDING PERMIT# applicable): DESCRIBE SCOPE OF WORK: Lit-,e OJ1 wid furnace SlAar• THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 0 YES-Select Scope:1=1 Srilce El Feeder [:]Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REQuiRED), El Data El Intercom El Thermostat El 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 n Permit is required for review of device location arid installation approval. El Other(List All): COO COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO El YES--Sea Below&Pg.2 By checking this box,I am stating that I have read arid understand all of WAC 296-460400,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 ELECTRICAILICENSURE: NO DYES-Sae Bekyw&Pg, flPursuant 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 an stating that I have completed and sae page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement, ',••040STAVAIN-0:-0RM471014 OWNER NAME: DOny1e. moo weil TENANT BUSINESS NAME(It Commercial): OWNER MAILING ADDRESS: STREET 1 0 10(0111 Pi s'c cm g'vtvetr STATE kk,ft 711: 015205 OWNER PHONE: 41-6° jI1- 1/b671 OWNER EMAIL: ',CONTRACTOR NAME: tb /VW CONTRACTOR ADDRESS: I *DIV 1.101 St- SW 4" cm' Mi)004 LZUte Terai Ct £11AIF I") 241, 41 4604 CONTRACTOR PHONE: k.,11, --lit• 111,1 CONTRACTOR EMAIL: Vilc-0 @,)`Mug flektale CorrifO(°1-,CO/Y1 CONTRACTOR LIC.#REQUIRED): 13)t-tiC14- Y),'LE) " CITY OF EVERETT BUSINESS LIC.Ill(REOUIRED): t.E . . PRIMARY CONTACT: NI OWNER DCONTRACTOR EOTHER(Please Specify) CONTACT NAIIAE: CONTACT PHONE: t17.6 • t1.- trItt.A.01 Maxvutt CONTACT EMAIL: AGREEMENT:I hereby certify that thi.IVe read end examined this apnikMon'anti know the same to be 11218 and camel. AI Anlvworls a laws end ordinances governing this type of work wig e coilpiefird whoihor specified herein Cf net The granting of a permit does not presume to give authority to yjoia2eor cancet the provisions of say other stele Or local taw regagerkig conS/NCIkm or The pesionriance of constractlon, That i ern uothorizod by the owner af this properly rowlorrn the work for which appticetion is made and comp*with the State Contractors Low 18.27 ROW end 200.260 WAC City of Everett Official Use Only PERMIT#: • 7,01,•11 E ‘0‘,014 r- 00( OurnartAuthonzeri Agent 1:14:re Date (Revised 1/1112019) Page 1-Application