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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> • ,, ,,,,,,,,i 3200 CEDAR STREET,EVERETT,WA 98201
<br /> AV—A
<br /> ‘111116111111k (P)425-257-8810 I FAX 425-257-8857 I(E)everettepa@everettwa,gov I Www,everettwa.goviperrnits
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<br /> PROJECT ADDRESS:6021 East Dr. Everett, WA 98203
<br /> PROJECT TYPE:E1NEW CONSTRUCTION El ADDITION lia-7TENANT IMPROVIVIENT :REMODEL
<br /> aF t3 -13
<br /> BUILDING USE: rR 0 TOWNHOUSE ruFtEx r---bDu }MULTI-FAMILY-it OF UNITS: 0 COMMERCIAL
<br /> BUILDING AREA 1080 sq ft
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<br /> CONTRACT PRICE OF WORK:•.$700 ASSOCIATED BUILDING PERMIT if(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? 0ES-#OF DEVICES:
<br /> 0 NO
<br /> L%4
<br /> IS THIS.A FIRE ALARM PERMIT? 0 0 El tYESPlans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF VVORK: Electrical branch circuits 30A&60A 240V for heat pump and furnace
<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> By checking this box,I am stating that I have read and understand all of WAC 296468-900,selected the specific reason on page 2
<br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page.2 require Plan Review.
<br /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:
<br /> TaPursuant to RCW19.28.261,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 signed the
<br /> see Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement,
<br /> CON**V"'tN#61tK4t0N" Ittitre-ttd.::1.,:::*04-;
<br /> OWNER NAME: James Moffat TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 8021 East Dr.
<br /> cfry Everett STATE WA z 98203 1
<br /> OWNER PHONE: 425-697-0833 OWNER EMAIL:
<br /> CONTRACTOR NAME: Rhema Electric, LLC
<br /> CONTRACTOR ADDRESS: striscr 628 S. Spruce St.
<br /> cm, Burlington STATE WA98233
<br /> 7,
<br /> CONTRACTOR PHONE:360416-8227 CONTRACTOR EMAIL:davea@rhemaeledric=c0rn
<br /> CONTRACTOR LIC.CREOuIRED):RHEMAEL9400H [CITY OF EVERETT BUSINESS LIC.#(nsnotnED):45783
<br /> PRIMARY CONTACT: IOWNER IE:„ZONTRACTOR tgiOTHER(Please Specify)
<br /> CONTACT NAME: 'CONTACT PHONE: 360-391-1884
<br /> Dave Alaniz CONTACT EMAIL: davea@rhemaelectric.com
<br /> AGREEMENT;I hereby certify that I have read and examined this application and know the same to be true end correct. All provisions of laws and ordinances
<br /> governing this type of wo*will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel Me
<br /> provisions of any other state or local law regulating construction or the performance of construction. That I em authorized by the owner of this properly to perforin the
<br /> k for which applicaticat is made and I comply with the State Contractors Law 1 IL 27ticW and 296.200 WAC.
<br /> City of Everett Official Use Only
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<br /> li 2 bili
<br /> ner/Auffierized Agent Signature 0 e
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<br /> PERMIT#
<br /> ( .--
<br /> Vtt 4-
<br /> (Revised 10/30/2018)
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