807 40TH PL 2020-02-24 - Laserfiche WebLink

ELECTRICAL PERIIIIIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 807 40TH PL BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ©SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION &'DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 5761 'ASSOCIATED.. B - m BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install a new gas furnace in same location, no new gas piping, and install a new thermostat. ........_......_...................____. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO C YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ®Thermostat ❑Audio El Secure Access ❑ Security System El 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: © NO IIS YES--See Below&Pg.2 S 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 V 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: ONO EYES-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. ! QNT + T NFAR MATION -77' OWNER NAME: Karen Wallace TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 807 40th PI CITY Everett STATE WA Z,P 98201 OWNER PHONE:425-210-4177 OWNER EMAIL:klw807@frontier.com CONTRACTOR NAME: Day and Nite Plumbing and Heating CONTRACTOR ADDRESS: STREET 16614 13th Ave W CITY Lynnwood STATE WA ZIP 98037 CONTRACTOR PHONE:425-775-6464 CONTRACTOR EMAIL:bryan@dayandnite.net CONTRACTOR LIC.#(REQUIRED):DAYNIPH944RQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019741 PRIMARY CONTACT: ['OWNER ❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-210-4177 Karen Wallace CONTACT EMAIL:klw807@frontier.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 WAG. City of Everett Official Use Only PERMIT#: li l ✓ c lL' 11/9/19 OW�ierlAet prized Agent Signature „. Date (Revised 1/11/2019) Page 1-Application