605 40TH PL 2019-11-15 - Laserfiche WebLink

ma L ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 nnvw.everettwa.govtpermits ,: PROJEcT SITE INFORMATIO . ,R:, 't' PROJECT ADDRESS: 605 40th PL Everett 98201 BUILDING AREA: sq ft C PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT El REMODEL BUILDING USE: Li SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL /CAI.AP,p _. TlON.IP4 T. ATI() . .RIPT1O . RK tea . . ,.:, CONTRACT PRICE OF WORK:$ 1850 ASSOCIATED BUILDING PERMIT#(if applicable): e ESCRIBE SCOPE OF WORK: -anel Change I . Tc _T!•. I. e T • • .I. SCOPE' SELECT ^LL TH^T •PPLY) UNE VOLTAGE WORK? ❑NO E]YES-Select Scope:El Service El Feeder ❑Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO 0 YES-#of Devices: 'i. ; SELECT SCOPE(REQUIRED): ElData ElIntercom ❑Thermostat ❑Audio ElSecure Access CISecurity System 4. ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional i' Fire Alarm Permit is required for review of device location and installation approval. El Other List All): ki - :- .. ;.- CODE COMPLIANCE - - p IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACIUTIES: ❑NO D YES—See Below&Pg.2 El 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 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:ONO DYES-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 receives an exemption from this licensing/certification requirement. :; t,, . , ,,.,' *'.,.. 4 Y .. .GONI. A rlumpORMAT O sz r Zi tt p , 44--':::‘'1'- OWNER NAME: Cheryl Keegan TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 605 40th PL , Everett STATE WA ZIP 98201 OWNER PHONE:na OWNER EMAIL:nB - CONTRACTOR NAME: In Haouse Electrical Services, inc. CONTRACTOR ADDRESS: STREET 1530 117th DR SE cnY Lake Stevens STATE WA ZIP 98258 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:Ihepermits@gmail.COm CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER ❑CONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4253209149 Kelsey CONTACT EMAIL:kelsey@inhouseelectric.com +. AGREEMENT:I hereby certify that t have read and examined this application and know the sante to be true and correct. All provisions of laws end ordinances governing this type of work wilt 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 consfructio • •performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I • .< wit the Ste a Con!: to, aw 18.27 RCW and 296.200 WAC. City of Everett Official Use Only 2{ PERMIT#: ArJ►,114 4 to/3/1q E VA 0 - OLk 7 , 0 w•'lAuthorized gent Signature Jr Date (Revised 1/10019) Page 1-Application Scanned with CamScanner