1615 SE EVERETT MALL WAY 2019-09-05

V tf` tT ✓ ) ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits 4t7T PROJECT SITE INFORMATION PROJECT ADDRESS: 1615 SE Everett Mall Way PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ®TENANT IMPROVMENT EREMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 12 COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION ifoa.„,,,,,\± CONTRACT PRICE OF WORK:$500.00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑ NO ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? �❑ NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Remove power to old furnace and rehook new furnace THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: laBy 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 riot See Page 2 require Plan Review. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑ 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Cypress Lawn Memorial Park TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET '1615 SE Everett Mall Way CITY Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Rhema Electric CONTRACTOR ADDRESS: STREET 628 S Spruce St efT1, Burlington STATE WA 31,_98233 CONTRACTOR PHONE:360-416-8227 CONTRACTOR EMAIL: daveb@rhemaelectric.com CONTRACTOR LIC,#(REQUIRED):RHEMAEL940DH CITY OF EVERETT BUSINESS LIC,#(REO IRED): 45783 PRIMARY CONTACT: O OWNER 1:;/'0ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-630-0164 Dave Buben CONTACT EMAIL: Ciaveb C7 rhemaelectric.corn AGREEMENT:/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 em authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 15.27 ROW and 296.200 WAC. City of Everett Official Use Only PERMIT# Owne a. horiz Agent Signature Dat,, (Revised 10130/2018) Page 1 of 3