4813 ALPINE DR 2019-10-30 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 i(E)everettepsfteverettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4813 Alpine DR Everett 98203 BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE 0 DUPLEX ❑ADU LI MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICALAPPf ICTION'INFORMATION &DESCRIPTION OFWORK. - CONTRACT PRICE OF WORK:$ 1500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (1) new circuit for lighting and receptacles, (1) new circuit for heaters THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope:❑Service ❑Feeder ❑✓ Circuits-#:2 ❑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): 14000DE,COMPLIANCIM IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO ❑YES—See Below&Pg.2 (l By checking this box,I am stating that I have read and understand all of WAC 296.468-900,selected the specific reason on page 2 I I 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 DYES-See Below&Pg.3 C 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 pa 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. _ ;' X 4:1*AI AC NTACT- I FORMATION l , . OWNER NAME:Joan Noel TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4813 Alpine DR crry Everett STATE WA zrP 98203 OWNER PHONE:na OWNER EMAIL:na CONTRACTOR NAME: In House Electrical Services, Inc. CONTRACTOR ADDRESS: sTREET1530 117th DR SE cm, Lake Stevens STATE WA zfP 98258 CONTRACTOR PHONE:4257603203 !CONTRACTOR EMAIL:kelsey@inhouseelectric.com CONTRACTOR LIC.#(REQUIRED: CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:Kelsey CONTACT PHONE:4257603203 CONTACT EMAIL:kelsey@inhouseelectric.com AGREEMENT:1 hereby certify that!have read: •exa •lned this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be • ,leted whether sp= red herein.r 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 :•utating c. emotion or the•=rformance o construction. That lam authorized by the owner of this property to perform the work for which application is made and comply ' t. a Contract. r: 7 RCW,nd 296.200 WAC. City of Everett Official Use Only PERMIT#: 9 er/Author zed Agent -g ature Date (Revised lf11/2019) Page 1-Application Scanned with CamScanner