2101 RUCKER AVE 2019-11-07 - Laserfiche WebLink

ECTRICAL PERMIT APPLI""TION �_ CITY OF EVERETT PERMIT SERVICE:':. y - 3200 CEDAR STREET,EVERETT.WA 982ui (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps(c evuretlwa.gov I wrnn.evcrettwa.gov/perrraits PROJECT SITE INFORMATION PROJECT ADDRESS: 2101 Rucker Ave��Unti 4 & 5 Everett 98201 BUILDING AREA: sq tt PROJECT TYPE: [1:1 NEW CONSTRUCTION _7 ADDITION ❑ TENANT IMPROVMENT l'1 REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU [ MULTI-FAMILY-1/OF UNITS'6? ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (2) 20 amp circuits for hood fans, (1) 20 amp circuit for heater THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑Service ❑Feeder [Circuits-#:3 ❑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. El 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg.3 Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sate,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. t CONTACT INFORMATION. OWNER NAME: Richard Sullivan TENANT BUSINESS NAME(if Commercial): OWNER MAILING ADDRESS: STREET 2101 Rucker AVE �y CITY EVerett STATE WA IPP 98201 OWNER PHONE:na OWNER EMAIL:na CONTRACTOR NAME: In House Electrical Services, Inc. CONTRACTOR ADDRESS: STRUT 1530 117th DR SE CITY Lake Stevens STATE WA ZIP 98256 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:ihepermits@gmail.com CONTRACTOR LIC.#(REQUIRED):inhueS952gg (CITY OF EVERETT BUSINESS LIC.#(REQUIRED):04168 PRIMARY CONTACT: DOWNER [CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 Kelsey CONTACT EMAIL:iheperrnits@gmail.com AGREEME . hereby ce^y that I have re= and exami ad this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of v wit be comp•ted whether ap ified herein not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local f regut ting co truckon or the p= o goof onstruelion. That tam authorized by the owner of this property to perform the work for which appfi^ahon is made and t co ly with t o Ste:Contractors Law 8 ROW d 295200 WAC City of Everett Official Use Only PERMIT#: Owne,Authori =d tent S rnature Date (Revised 1/11/2019) Page 1-Application 1/