3821 SHORE AVE 2019-11-07 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 ; FAX 425-257-8857 1(E)everetteps©everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION4, ' ...' , ' PROJECT ADDRESS: 3821 SHORE AVE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL.LAPP ICAMMNF.OR TKNM.&.v,,OESCR1pTIONMOR .. ',,V CONTRACT PRICE OF WORK:$ 250.00 JASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: CIRCUIT FOR HEAT PUMP PLUS T-STAT 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 ❑ 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. Cl Other(List All): ',, ,40,N-:-314,,, ._:,F '% j, _ ODE Es COMPLIANCE,eet aff40,:-).}, IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: E 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 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,goomst *4`:. . .. owCONTACT==,INI~C'IR.NIIITIONt,6,:tivi;tv1 _...... �,..... . .. : OWNER NAME: DOUGLAS HADLEY TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3821 SHORE AVE ciry EVERETT STATE WA zip 98203 OWNER PHONE:425-348-7218 OWNER EMAIL: CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY CITY EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:DEBBIE@CMHEATNG COM CONTRACTOR LIC.#(REQUIRED): CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016098 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: c fC CONTACT PHONE:425-259-0550 DEBBIE CONTACT EMAIL:DEBBIER@CMHEATING.COM tyrGREEMENr-l hereby certify that l have read and examined this application and know the same to be true and correct. Ni provisions of laws and ordinances governing this 1 pe 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 icompty with the State Contractors Law 18.27 RCW and 296.200 WAC. city of Everett Official Use Only t PERMIT#: ce. 8.19-(9 E \ D - � fl Owner/Author xed Agent Signa re Date (Revised 1/11/2019) Page 1-Application 1: