1318 37TH ST 2220 BLDG 2 2023-06-09

— ' ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES a , 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everettepps@everettwagov (��yw{pww.everettwa.gov/permits 44-'444';',4''' ...: P ECT•,SITEIN OR ■`ON P. .. PROJECT ADDRESS: j 18 37 S fi F 022,o BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION :l TENANT IMPROVMENT El REMODEL BUILDING USE: 'SFR ❑TOWNHOUSE ❑ DUPLEX Cl ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ,: YY.\otmCAL APP ICA I FORM .., .ONt .DE$R PTtON O , TOR CONTRACT PRICE OF WORK: $ — ASSOCIATED BUILDING PERMIT#(if applicable). DESCRIBE SCOPE OF WORK: Ref LicD, ) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) ILINE VOLTAGE WORK? NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? Xi 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): 7 -.- . P ANCE �"'� IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ONO l_,-f YES--See Below&Pg.2 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 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: NO YES-See Below&Pg. 3 r---1 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. �.. .yl:� F� 9� s1i+1FtQRMAt1©N Ce OWNER NAME: Lyre.- L . 'lt TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 13M 3-7+4A Ct-j- 4 ZZZO 9 Icer Evei x STATE Do Fl ZIP is OWNER PHONE: 425 25 2. 41 OWNER EMAIL: CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY CITY EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016098 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-259-0550 �J CONTACT EMAIL: hQ- C, ,.1' r\+C_O4vAGREEMEieiao I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions q!ws and ord lances 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 I 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 Stale Contractors Law 18 27 RCW and 296,200 WAC City of Everett Official Use Only PERMIT# !o.$• fR E C\ \ - OwneAuthorized Agent gnature Date (Revised 1/11/2019) Page 1-Application v 1