16 FERN RD 2020-02-07 - Laserfiche WebLink

I li ELECTRICAL PERMIT APPLICATION ',' .,t,p v. EVERETT Vl CITY OF EVERETT PERMIT SERVICES i 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@everettwa.govl www.everettwa.gov/permits q— ZP- S y PR04goiliTE 1NFORMA7'IONr °M =- PROJECT ADDRESS: 16 FERN RD, EVERETT, WA 98203 BUILDING AREA: 1404 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPI:ICATION JNFORMATION & DEScRIPTION O WORKR # ,,,, .S:„s. . CONTRACT PRICE OF WORK:$ 1350 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: INSTALL NEW CIRCUIT FOR SINGLE ZONE DUCTLESS HEAT PUMP THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LiNE VOLTAGE WORK? 0 NO ❑YES-Select Scope:❑Service ❑Feeder 0 Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#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 checking 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 See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ENO 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 en exemption from this licensing/certification requirement. AEM_,__._MIMMWLtSA=VVAONT/_#G�'�NFPR1MlA ibN.� n 7x ,-V:Ste � :Zs - : OWNER NAME: DON BEEDLE TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 16 FERN RD CITY EVERETT STATE WA ZIP 98203 OWNER PHONE:425-240-6762 OWNER EMAIL:GBEE59@HOTMAIL.COM CONTRACTOR NAME: EVERGREEN STATE HEAT&AC CONTRACTOR ADDRESS: sTREET2120 PACIFIC AVE GnY EVERETT STATE WA 21P 98201 CONTRACTOR PHONE:425-252-3114 CONTRACTOR EMAiL:LESLIE@ESSMWA.COM CONTRACTOR LIC.#(REQUIRED):EVERGSS928RN CITY OF EVERETT BUSINESS LIC.#(REQUIRED):007955 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:LESLIE CONTACT PHONE:425-252-3114 CONTACT EMAIL:LESLIE@ESSMWA.COM AGREEMENT:t 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 PERMIT#: ji P (PaiinL t� E ��OS -CSOOw er/Authorized Agture Date (Revised 1/11/2019) Page 1-A Ii tion PP