4711 CASTLE LN 2019-09-04 - Laserfiche WebLink

NEN ELECTRICAL PERMIT APPLR;ATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 4711 Castle LN, Everett BUILDING AREA: i-),C10 J c•-4 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑✓ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL ;,, ELECTRICAL APPLICATION INFORMATION & DESCRIPTION,OF WORK CONTRACT PRICE OF WORK: $ 900.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: New A/C circuit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO El YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#:1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO El YES-#of Devices:_ SELECT SCOPE(REQUIRED): El Data El Intercom El Thermostat ❑Audio El Secure Access El 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO El YES--See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-468-900,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: ElNO EYES-See Below&Pg.3 ( 7 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. CONTACT, NFORMATION OWNER NAME: Stacy & Margaret Carmen TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4711 Castle LN c,n Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Home Run Electric LLC CONTRACTOR ADDRESS: srREEr21 118 66th Ave W C,7y Lynnwood STATE WA ZIP 98036 CONTRACTOR PHONE:425-489-0791 CONTRACTOR EMAIL:gdeliVery@hOrlleruneleCtriClIC.COm CONTRACTOR LIC.#(REQUIRED):HOMERRE974K2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):041019 PRIMARY CONTACT: DOWNER EICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:MIKE SMITH CONTACT PHONE: 206-850-2401 CONTACT EMAIL:gdelivery@homerunelectricllc.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 1 compt, with the State Contractors Law/8.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: E F ® � ,. la hoc® _•r'•uihorized Agent Signa re Date 9 9 (Revised 1/11/2019) Page 1-Application