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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-267-8810 I FAX 425-25T-8857 1(E)everetteps@everettwa.gov I www.everettwa.govipermits <br /> ,2-414 <br /> PROJECT ADDRESS: 1430 W. Casino Rd Unit 54 BUILDING AREA: sq ft <br /> PROJECT TYPE 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> IN.IL b <br /> CONTRACT PRICE OF WORK:$ 3550 ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Replace existing gas furnace with new gas furnace; no new gas piping <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? gi NO 0 YES-Select Scope:0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO Q YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 10 Thermostat 0 Audio 0 Secure Access 0 Security System <br /> 0 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 /> O Other(List All).,..__ <br /> IS THIS <br /> �rPERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: ®NO Q YES--See Below&Pg.2 <br /> IL— By checking this box,I am stating that I have read and understand all of WAC 296-4613.900,selected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I meet ail 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:ONO OYES-See Below&Pg.3 <br /> ElPursuant to RCW 10.28.261,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 <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> ,Nrid <br /> d <br /> OWNER NAME: Christine Soler TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1430 W.Casino Rd Unit 54 <br /> CITY Everett STATE WA zip 98204 <br /> OWNER PHONE:425-626-0347 OWNER EMAIL.:cslovespurple©yahoo,com <br /> CONTRACTOR NAME: Day and Nite Plumbing and Heating <br /> CONTRACTOR ADDRESS: STREET 16614 13th Ave W <br /> oily Lynnwood arm WA zia 98037 <br /> CONTRACTOR PHONE:425-775-6464 CONTRACTOR EMAIL:bryan©dayandnite.net <br /> CONTRACTOR LIC.#(REQUIRED) DAYNIPH944RQ ,CITY OF EVERETT BUSINESS LIC,#(REQUIRED):019741 <br /> . <br /> PRIMARY CONTACT: iZIOVVNER OCONTRACTOR- OOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-626-0347 <br /> Christine Soler CONTACT EMAIL:cslovespurple@yahoo.com <br /> AGREEMENT!hereby certify thet t have read and examined th application and know the same to be true and correct.A!l provisions of laws and ordinances 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 lam authorized by the owner of this property to perform the work for which application Is made and! <br /> comply with the Slate Contractors Law 18.27 RCW and 208.200 WAC. City of Everett Official Use Snit <br /> PERMIT#: <br /> C1ner uthorized - gnature Date (Revised 1/11/2019) Page 1-Application <br />