1617 RUCKER AVE 2019-09-24 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES ' _ 3200 CEDAR STREET, EVERETT,WA 98201 vii .,tif (P)425-257-8810 I FAX 425-257-8857 1(E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION �' PROJECT ADDRESS:1617 RUCKER AVE PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS; ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$250.00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#OF DEVICES:1 IS THIS A FIRE ALARM PERMIT? 0 NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: DISCONNECT/RECONNECT GAS FURNACE IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓0 NO El YES--See Below&Pg.2 IIBychecking 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg. 3 7 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:TARA ROHRBACH TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 161 7 RUCKER AVE CITY EVERETT STATE WA Z,p 98201 OWNER PHONE:206-898-7222 OWNER EMAIL: CONTRACTOR NAME:C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY cin EVERETT STATE WA ZAP 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:DEBBIE@CMHEATING.COM CONTRACTOR LIC,#(RE0UIRED):CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016098 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-259-0550 DEBBIE CONTACT EMAIL:DEBBIE@CMHEATING.COM AGREEMENT:I 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 am authorized by the owner of this property to perform the work for which application is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 1 ` .� 2/6/19 C-- \Ct 02 a3 l Owner Authorized Agent S' nature 71, Date (Revised 11/5/2018) Page 1-Application (3 )