4403 RIDGEMONT DR 2019-09-24 - Laserfiche WebLink

ELECTRICAL 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 to PROJECT ADDRESS: 4403 RIDGEMONT DR BUILDING AREA: 2154 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ©REMODEL BUILDING USE: ©SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR HEAT PUMP INSTALL- TSTAT CONNECTIN THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope:❑Service ❑ Feeder Circuits-#: t ❑Complete Re-wire LOW VOLTAGE WORK? 0 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 far review of device location and installation approval. ❑Other(List All): Y■�ycam IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: QNO Li 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: WINO DYES-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. a�� .�..zriu� ,....TM��l �r,�. ', .,• .:.'e��'"``'''�.:'�"`a e.-.. ; „� ^ r`;;..".�. ....:.::>1�. �.. .. . �.�. .. � :Via. OWNER NAME: MARK OLSON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4403 RIDGEMONT DR .. .. STATE WA ZIP 98203 v,r, EVERETT OWNER PHONE:425-750-4847 f OWNER EMAIL:Mark@mgolsonlaw,com CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY CITY EVERETT STATE WA z,a 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM CONTRACTOR LIC,#(REQUIRED): CMHEAMH8770N CITY OF EVERETT BUSINESS LIC.#REQUIRED): 016098 .:. PRIMARY CONTACT: DOWNER ZCONTRACTOR ("OTHER(Please Specify) CONTACT NAME: �//�� CONTACT PHONE:425-259-0550 KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM AGREEMENT l hereby certify that/have read and examined this application and know the same to be true and:correct. All provistanE of laws and ordteances 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 t 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 296.200 WAC. City of Everett Official Use Only PERMIT#: 7 ,4C‘,/1:/--/W4 f Lt r'!tl 08/08/19 E l b I Owner/Authorized Agent Signature C/ Date (Revised 1/1112019) Page 1-Application