808 55TH PL SW 2019-11-15 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES filE 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I wwweverettwa.gov/permits '7 :P!ROJEC SITE INFORMATION PROJECT ADDRESS: 808 55TH PL SW #B BUILDING AREA: sq ft PROJECT TYPE; ❑NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: D SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ' - I.ECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK ; CONTPA'.T PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable): DESCI /E SCOPE OF WORK: REPLACE ELECTRIC FURNACE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LIrtE VOLTAGE WORK? ❑ NO ❑ YES -Select Scope. ❑Service ❑ Feeder ❑Circuits-#. ❑Complete Re-wire LC V VOLTAGE WORK? ❑ NO ❑YES-#of Devices: Sr' 'CT 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):ADD/ALTER CIRCUIT TO REPLACE ELECTRIC FURNACE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO El 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? require Plan Review. ii; ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ZNO EYES-See Below& Pg. 3 Pursuant to RCVV 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. CONTACT INFORMATION OWNER NAME: SUE HOLDMAN TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 808 55TH PL SW#B ciTY EVERETT STATE WA zip 98203 OWNER PHONE:425-338-0804 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: CONTRAC TOR LIC. //(REQUIRED): CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016098 ® e PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: C C CONTACT PHONE:425-259-0550 DEBBIE CONTACT EMAIL:DEBBIE@CMHEATING.COM AGREEMENT'.I hereby certify Mail have read and examined this application and know the same to be true and correct. All provisions of taws and ordinances governing this type of work'ill 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 lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only _ ch. PERMIT#: -4e'.. :,:z. } E i g 1 OwnarlA horiz i �� OLI d Agent Sign ure 6 Date (Revised 1/11/2019) Page i-Application 1