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<br /> ELECTRICAL PERMIT APPLICATION
<br /> is: CITY OF EVERETT PERMIT SERVICES, _ : 3200 CEDAR STREET,EVERETT,WA 98201
<br /> } (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.,everettwa,gov/permits
<br /> PROJECT ADDRESS: 7529 RAINIER AVE ,BUILDING AREA: 930 sq ft
<br /> PROJECT TYPE: C,NEW CONSTRUCTION ❑ADDITION ._❑TENANT IMPROVMENT _©REMODEL ,e.
<br /> 1BUILDING USE: 12I SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> ADD CIRCUIT FOR SINGLE ZONE DUCTLESS INSTALL
<br /> ,,THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> ' ` LINE VOLTAGE WORK? ✓❑NO ❑YES-Select Scope:❑Service„ ❑Feeder ❑ Circuits-#:1 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑✓ NO El YES-#of Devices: -'
<br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access El Security System _
<br /> ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and Installation approval.
<br /> ❑Other(List All):
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ;NO: ® YES--See Below&Pg.2 ,
<br /> 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
<br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review. „
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE::mit NO EYES-See Below&Pg.
<br /> EPursuant to RCW 19,28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> without the proper electrical licensing and certification,or exemption. By checking this box,I am stating that I have completed and n?'
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> �? ''':,`' ',.':'!„,:,,,:4',!•'':'',W71"
<br /> DAVID B R . �p�NT `,°' _ �iwTI°,. i :� � , v.:::4,,,'•',... ..ie,..4-:. ,-1-',7
<br /> OWNER NAME:
<br /> ANDVOLD TENANT,BUSINESS NAME(if Commercial):: i:• `
<br /> OWNER MAILING ADDRESS:._ STREET 7529 RAINIER AVE
<br /> CITY EVERETT STATE WA zip 98203 .g,
<br /> OWNER PHONE:425-353-3953 .
<br /> !OwNER EMAIL KAIANA@CMHEATING.COM
<br /> '::CONTRACTOR NAME: C.M. HEATING INC
<br /> .CONTRACTOR ADDRESS: STREET 1415 BROADWAY
<br /> CITY EVERETT zip 98201_
<br /> t ... STATE,WA _,f'
<br /> ° CONTRACTOR PHO.NE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM
<br /> • ONTRACTOR LIC #(! -UIREt ) CMHEAMH877DN
<br /> CITY OF EVERETT BUSINESS LIC.# REtU1k2,,_D 016098
<br /> PRIMARY CONTACT:• DOWNER ©CONTRACTOR ❑OTHER(Please Specify)
<br /> -CONTACT NAME: CONTACT PHONE:425-259-0550
<br /> KAI LANA
<br /> CONTACT EMAIL;KAILANA@CMHEATiNG.COM s
<br /> GREEMENT:.1 trerebycertifyfhatlhave read and'examined ibis appl(69fPr orrrriaitlw MO same to ate tru0 and!purred A/(p'vtsit3tis Of taws and ordinance*y ;governing this ,
<br /> 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
<br /> local law regulating construction or the performance of construction,. That l am authorized by the owner of this property to perform the work for which application is made and t
<br /> ?,,1comply with the State Contractors Law 18.27 RCW and 296,200 WAC. City of Everett Officl@l Use only
<br /> #HERMIT#.:
<br /> i K Y C�.L-.t ,t 1 C` 10/30/19 E ff111- 0\')_
<br /> OwnertAuthorized Agent Signature Dote (ROWSOX/////204 ) Page 1-Application I-
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