14 77TH ST SE 2020-01-22 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES - 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)reverrettepsC@e�veerettwa.gov I www.everettwa.gov/permits "..� ;. � u .',': "�'`'!rR .�E,C'�''S!T IINFORMAT ON &�a' . ,,.iia '' :',i„;; ,.„•3�„£v.. �.,. t3` PROJECT ADDRESS: 14 77th St SW BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ©SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL .0:.. k E�l�i,TRII04 ARP4104T1ON.1NFORMAT$ N & DESC IpTIION .NORM ..NAW:AZ. CONTRACT PRICE OF WORK:$ 4273.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install a new gas furnace. 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-If 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. ❑Other(List All): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO ❑YES--See Below&Pg.2 By chec , I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 V I of this applicationkingthisbox(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 OYES-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. cover CT INFiORMA"�' t 1!j., .�r. �. M - OWNER NAME: Reiko Enloe TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 14 77th St SW CITY Everett STATE WA ZIP OWNER PHONE:425-347-3460 OWNER EMAIL:reikore@hotmail.com CONTRACTOR NAME: Day and Nite Plumbing and Heating CONTRACTOR ADDRESS: STREET 16614 13th Ave W CITY Lynnwood STATE WA ZIP 98037 CONTRACTOR PHONE:425-775-6464 CONTRACTOR EMAIL:bryan@dayandnite.net CONTRACTOR LIC.#REQUIRED): H944RQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019741 PRIMARY CONTACT: ©OWNER ❑CONTRACTOR ['OTHER(Please Specify) � � CONTACT NAME: CONTACT PHONE:425-347-3460 Reiko Enloe CONTACT EMAIL:reikore@hotmail.com AGREEMENT:1 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 \ -11764-",(4 � PERMIT#: ;4'11171— . t > . /6 EOwnerlAurized Agent Signature Dale (Revised 1/11/2019) Page 1-ApplIcatIon pp