1720 124TH PL SE 2020-01-23 - Laserfiche WebLink

1.12 ELECTRICAL PERMIT APPLIt.,,LIFION CITY OF EVERETT'PERMIT SERVICES EVERETT 320n CEDAR STREET,EVERETT,WA 482M Pj 425-257-H1U I FAX 425-257-B857 I(E)evaraitapagaverattwa.gov I uww.ev,arettwa,govieermitt S PIG PROJECT SITE INFORMATION PROJECT ADDRESS: 1720 124TH FL SE BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION El IENAN1 IMPROVMEN LI REMODEL BUILDING USE: RI SFR El TOWNHOUSE EI DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: COMMERCIAl, ELECTRICA Pt-MA*110N INFORMATI0N-A DESCRIPTION OF WQRR CONTRACT PRICE OF WORK:$ 600 ASSOCIATED BUILDING PERMIT# epplicable): .„. DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR AC AND FURNACE INSTALL THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO El YES-Select Scope;0 Service El Feeder D Circuits4:1 Cornolete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(I4EQUIRLD): El Data Li Intercom D Thermostat 0 Audio CI Secure Access El Security System [71 Fire Alarm-Installations under this pen-nit only include electrical wiring rough-in of the system.An additional hire Alarm Permit is required for review of device location and Installation approval, D Other(List All): cop IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 12 NO a YES --Son Deiow&Pg, 2 By chocking 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 Sue Page 2 require Plan Review, ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: Ell NO IVES-see Below&Pg,3 flPursuant to ROW 19,28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing end certification,or exemption.By checking this box.I am stating that I have completed and Sac page 3 signed the AFFIDAVIT on page 3 of this application to ri4ceive on exerriplion from this licensingicertification requirement. 1777:41riff-.:.Sge.:iii& TACTINFIC'RMATI°14 OWNER NAME° WILLIAM DOWSING TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sie,i-t 1720 124TH PL SE ,;„,, EVERETT swE WA 2ip 98208 OWNER PHONE:2069027842 OWNER EMAIL;DOWSING8©GMAIL.COM ARZPVI, CONTRACTOR NAME: BLUE FLAME HEATING AND AIR CONTRACTOR ADDRESS: zs HU 7116 220TH ST SW #1 crry MOUNTLAKE TERRACE TFWA zic, 98043 CONTRACTOR PHONE:4257717139 CONTRACTOR EMAIL:I NFO@BLUEFLAMECOMFORT.COM CONTRACTOR LIC.#(REOUIRED):BLUEFFH 827RK CITY OF EVERETT BUSINESS LIC.MREQUIRED):80'138 PRIMARY CONTACT: *DOWNER OCONTRACTOR [l]OTHER(Please Specify) CONTACT NAME: CONTACT pHoNE:4257717139 DENISE CONTACT EMAiL:INFO@BLLIEFLAMECOMFORT,COM iir3R/t Mt NT: hereby curtity firer Ihave read and asamtned this appkuathm and knew the same to be oue and coma A t proviStertiPt laWs arid ordAwrices ooverning this typo ofmark wIW tte curreptuted whether specified herein or not The greeting of a pent*does not prestene to 9iVe*tithe*to vktiate c cancer the wavierona of any other state or teed law pustulating conelnislion critter performance cf,construction, That I tern. ted by the owner at 6z:we/forty to Rot-Iwo(ho aort for which eppfication is made and I comply with rho Mild Conireckve Law l27 RCM,and 256.190 WAG. City of Everett Official the Only PERMIT-4: EN66- 1Lb Owner/Authorized t Signature Date (Revrsed 1/1-1/20f9) Page 1-Application