4820 DELAWARE AVE 2020-02-06 - 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 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4820 Delaware Ave BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 1-1 REMODEL BUILDING USE: ❑✓ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL iiafikltglkECTRiCAL APPLICATION:INFOR .,.,'..i !IA3t sp ,i ?rot!#o 1.1 ag . VO' .., .. CONTRACT PRICE OF WORK:$ 7,542.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install a new gas furnace, and a new thermostat. 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-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom Q 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). ,.. CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7 NO ❑YES See Below&Pg.2 ! By checking , am that I enW80, d the specific reason on page 2 Y of this application thisbox(see I nextstating page),ANDhave PlanrReviewadad isunderstand NOT requiredallof becauseAG296-46I meet-90all of theselectel folowing sub sections that do not See Page 2 require Plan Review. E1 YES YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: E t-1 INO t_1YES-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 `'i. ,. OWNER NAME: Robert & Vicki Springer TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4820 Delaware Ave C,,„ Everett STATE WA ZIP 98203 OWNER PHONE:425-760-4682 OWNER EMAIL:golffan53@Iive.com CONTRACTOR NAME: Day and Nite Plumbing and Heating CONTRACTOR ADDRESS: STREET 16614 13th Ave W CITY Lynnwood STATE WA 7,P 98037 CONTRACTOR PHONE:425-775-6464 CONTRACTOR EMAIL:bryan@dayandnite.net CONTRACTOR LIC.#(REQUIRED):DAYNIPH944RQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019741 PRIMARY CONTACT: DOVVNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Y1 CONTACT PHONE:425-760-4682 Robert Springer CONTACT EMAIL:golffan53@live.com AGREEMENT:thereby 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 tam authorized by the owner of this property to perform the work for which application is made and t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: - Ownerst uthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application