5607 1ST AVE SE 2019-09-17 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:5607 1st Ave SE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ®ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: IX SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 33: ELECTRICAL.APPUUCA'rION IN O*J 4 mON & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $500.00 ASSOCIATED BUILDING PERMIT#(if applicable)M 1 902-026 DESCRIBE SCOPE OF WORK: Like for Like Furnace replacement THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ®Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑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):Retrofit Furnace Replacement IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ';1 NO U 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®NO EYES-See Below&Pg. 3 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I/�I 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 INFORMATION- OWNER INF R ATIONOWNER NAME:Glorianne Bora TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5607 1st Ave SE CITY Everett STATE WA ziP 98203 OWNER PHONE:816-500-6492 OWNER EMAIL: Glorabora C7 yahoo.com CONTRACTOR NAME:Bob's Heating & Air Conditioning CONTRACTOR ADDRESS: STREET 14148 190th ST CITY Woodinville STATE WA ZIP 98072 CONTRACTOR PHONE: 800-840-3346 CONTRACTOR EMAIL: Spike@bobsheating.com CONTRACTOR LIC.#(REQUIRED);BOBSHHA850NJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):54967 PRIMARY CONTACT: ®OWNER ❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME:Glorianne CONTACT PHONE:816-500-6492 CONTACT EMAIL: GIorabora@yahoo.com AGREEMENT:i hereby certify that i have read and examined this appiication and knew The same to he true and correct. Alf provisions of laws end 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 296200 WAC. City of Everett Official Use Only PERMIT#: Ovoiceriku7sfid Agent Signature Date (Revised 111112079) Page 1-Application