5711 25TH AVE W 2019-11-15 - 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 j(E)everetieps(a:everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION - PROJECT ADDRESS: 5711 25th Ave. W Everett, Wa BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRIC. "J.1 .1.W1 14 INFP -RMATION & DESCRIPTION OF W CONTRACT PRICE OF WORK:$ 850 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Electrcial branch circuit for 240V heat pump and 120V Outlet THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? E NO E✓ YES-Select Scope: El Service El Feeder ❑✓ Circuits-#:2 E Complete Re-wire LOW VOLTAGE WORK? iElt NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): iJ Data ❑ Intercom El Thermostat ❑Audio El 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): CODE COMPLIANCE. l R,,'E �� t IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LJ NO E 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 Pian Review. In ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: L"_1NO DYES-See Below&Pg.3 1Pursuant 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. . CAONTACT INFORMATION OWNER NAME: Kavitha Chunchu TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5711 25th Ave. W c,Tv Everett srnn:WA „98203 OWNER PHONE:757-303-3471 OWNER EMAIL: CONTRACTOR NAME: Rhema Electric, LLC CONTRACTOR ADDRESS: STREET628 S. Spruce St. cry Burlington STATE WA ;15.98233 CONTRACTOR PHONE: 360416-8227 CONTRACTOR EMAIL: davea@rhemaeleCtriC.COm CONTRACTOR LIC.#(REQUIRED):RHEMAEL940DH CITY OF EVERETT BUSINESS LIC.#(REQUIRED):45783 PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: A CONTACT PHONE: 360-391-1884 Dave AlaniZ CONTACT EMAIL: davea@rhemaelectric.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 stale 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 complyWith the State Contractors Law 18.27 RCW and 296.200 WAD City of Everett Official Use Only PERMIT#: c • # z "€ I E \ '�J1—O 1 L lWner/Authorized'Agent Signature t to (Revised 1/11/2019) Page 1-Application