931 HOYT AVE 2019-09-23 - Laserfiche WebLink

INN 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 931 Hoyt Ave rBUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION E❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑E SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL,APPLICATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 350 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: heat pump and air handler change out THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? E❑ NO ❑ YES-Select Scope: ❑Service ❑Feeder ❑ Circuits-#: CI Complete Re-wire LOW VOLTAGE WORK? E❑ 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): CODE COMPLIANCE ,; IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: E�NO El 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: E❑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 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 NAME: Pat Howe TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 931 Hoyt Ave CITY Everett STATE WA zip 98201 OWNER PHONE:425-252-0433 OWNER EMAIL: CONTRACTOR NAME: BLACK LION HEATING & AIR CONDITIONING CONTRACTOR ADDRESS: STREET11001 118TH PL NE , KIRKLAND STATE WA ZIP 98033 CONTRACTOR PHONE:425-814-3944 CONTRACTOR EMAIL:brenda©blacklionhvac.Com CONTRACTOR LIC.#(REQUIRED):blacklh873gq CITY OF EVERETT BUSINESS LIC.#(REQUIRED):053541 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ,' CONTACT PHONE:425-814_3944 Brenda CONTACT EMAIL:brenda©backlionhvac.com AGREEMENT 1 hereby certify that I have ra€ f 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 spe fled 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 =w regulating construction or the pa•brrrtarace of construction. That I am authorized by the owner of this property to perform the work for which application is made and t cot %ty 1 the State Contractors Law 1.,27 RCW and 296,200 WAC. City of Everett Official Use Only PERMIT#: 5/17/2019 �J 5 ONS G t3 nr' ant Signatu a Date (Revised 1f11171)79) Page 1-Application