604 WARREN AVE 2019-09-24 - Laserfiche WebLink

ELECTRICAL PERMIT APPLILL TION OrErrCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 604 Warren Ave Everett, WA 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑✓ SFR El TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION I&'DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Alter 1 circuit for floor heat THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Secure Access ❑ Security System El 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: ❑ NO ❑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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO EYES-See Below&Pg.3 fl 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: John Mostrom TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 604 Warren Ave CITY Everett STATE WA zr 98201 OWNER PHONE:n/a OWNER EMAIL:n/a CONTRACTOR NAME: In House Electrical Services, Inc. CONTRACTOR ADDRESS: STREET 1530 117th DR SE Lake Stevens STATE WA zip 98258 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:ihePerin its©gmai l.co fl'1 CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 Kelsey CONTACT EMAIL:ihepermits@gmail.com AGREEM T:I hereby certify at I have and- .m .this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of ork will.e complet::wheth specifie. erein.r n.. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local aw regul.i .ns r-'on. the performance/of/con ruction. That I am authorized by the owner of this property to perform the work for which application is made and I co ply with e State antra .rs L- 18 7 RCWnd °6.200 WAC. City of Everett Official Use Only 7 - PERMIT#: i ((9 E O - o i l Owner/Authorized,Agent Signature (Revised 1/11/2019) Page 1-Application