215 100TH ST SW 2019-08-20 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits 4177. n : ECT RITE',INFORMATION tea` $r PROJECT ADDRESS: 215 100th St SW D303 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: I SFR ❑TOWNHOUSE El DUPLEX ❑ADU ® MULTI-FAMILY-#OF UNITS:1 ❑ COMMERCIAL ELEc" RI PLI TIIO.N, NFOR:NM .ti,.014,4 .. ON, , F woR i ai, CONTRACT PRICE OF WORK:$2,500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 3 alt circuits (can lights in living, dining, kitchen, and hall) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 2 YES-Select Scope: ❑Service ❑ Feeder ©Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio ❑ 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): ''''',-; ::'77-77'-';''','": ,,' ODE COMPLIANCE �.�.�.;L IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: U NO I=1 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: ❑✓NO DYES-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. ' 1W • IMOD t w � z ��. t'�NTA�'` 1�1 , OWNER NAME:MIke Flanagan TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREE,215 100th st SW D303 CITY STATE STATE WA Z,P98204 OWNER PHONE: 2065566355 OWNER EMAIL: mgflanagan130@gmail.conl CONTRACTOR NAME: switch Electric CONTRACTOR ADDRESS: STREET 7226 139th Ave NE CITY STATE Stevens STATE WA ZIP 98258 CONTRACTOR PHONE:425-244-5511 CONTRACTOR EMAIL:Service@myswltchelectrlc.com CONTRACTOR LIC.#(REQUIRED):b WI I(.EL91 I K CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 05255/ PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-376-7662 Tiffany Erickson CONTACT EMAIL:tiffany@myswitchelectric.com 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 for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#. 7J ----.-- L 2/26/19 E ki61(1- 1 I Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application