4719 BAKER DR 2020-01-21 - Laserfiche WebLink

Fa ELECTRICAL PERMIT APPLICATION i CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4719 Baker DR BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 350 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: AC ADD ON / THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY' LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service `per CI Feeder i2 Circuits-#: CI Complete Re-wire LOW VOLTAGE WORK? CI NO CI YES-#of De es: \ SELECT SCOPE(REQUIRED): CI Data CI Intercom ®Ther ostat ❑Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm-Installations\under t permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required'oi r ew of device location and installation approval. ❑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: NO 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. CONTACT INFORMATION OWNER NAME: James Goldade TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4719 Baker DR CITY redmond STATE wa ZIP 98052 OWNER PHONE: 425-299-6580 OWNER EMAIL: jmgoldade@comcast.net CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 18103 NE 68TH ST SE, C-200 CITY REDMOND STATE WA ZIP 98052 CONTRACTOR PHONE: 425-881-7920 CONTRACTOR EMAIL: PERMITS@MMCOMFORTSYSTEMS.COM CONTRACTOR LIC.#(REQUIRED): MMCOMCS839PT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 055245 PRIMARY CONTACT: ❑OWN ER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-629-1025 Jenah Barlow CONTACT EMAIL: PERMITS@MMCOMFORTSYSTEMS.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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 1 ' ( v . \ Gi E VA () • -- OR3 Owner+�4uth iz A nt S at a Date (Revised 1/11/2019) Page 1-Application