613 93RD ST SW 2020-02-25 - Laserfiche WebLink

won ELECTRICAL PERMIT APPLICATION EEVERETT CITY OF EVERETT PERMIT SERVICES v 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwagov I www,everettwa gov/permits ' PROJECT SITE INFORMATION [PROJECT ADDRESS: 613 93rd St SW !BUILDING AREA. sq ft [PROJECT TYPE: CI NEW CONSTRUCTION C]ADDITION! ❑TENANT IMPROVMENT 0 REMODEL LBUILDING,USE: El SFR El TOWNHOUSE CI DUPLEX 0 ADU ❑MULTI-FAMILY #OF UNITS: ❑COMMERCIAL :i .ELECTI 1 A:ll.L P1, JATIOH INFt' R IATi�ON„+ G` I1r. IICtrOf1.' ' R . .. sx .,gt ..- . ._ .y CONTRACT PRICE OF WORK $ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): M1910-105 DESCRIBE SCOPE OF WORK: LIKE IN KIND GAS FURNACE REPLACEMENT WITH TSTAT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO 0 YES-Select Scope:❑ Service. ❑ Feeder_.❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices: . SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom R]Thermostat ❑Audio El Secure Access El 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): ..��K ?:�'��... =�3„.. .�4\ .��-v�-,3',��.nv' _.waw....z��.S:Ai +P� £�'E :,;''''''::,:-4 �^�a'`a' �ai�3 r '4'.A-4i r li IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO YES--See Below&Pg,2 E 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: ❑✓NO LIYES-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. i yr 0,11 , ONTACT NFOORMA I e4 ;OWNER NAME: RICHARD CALDWELL TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 613 93rd St SW Cry EVERETT STATE WA ZIP 98204 OWNER PHONE:425-772-9557 OWNER EMAIL: CONTRACTOR NAME: WASHINGTON ENERGY SERVICES CONTRACTOR ADDRESS: STRr;ET3909 196TH ST SW CITY LYNNWOOD STATE WA zip 98201 CONTRACTOR PHONE:2063786613 CONTRACTOR EMAIL:HMCOORDINATORS@WASHINGTONENERGY.COM ' CONTRACTOR LIC.:#(REQUIREDD:WASHIES854NG CITY OF EVERETT BUSINESS LIC REQUIRED):54773 T PRIMARY CONTACT: # . DOWNER LICONTRACTOR []OTI.IER(Please Specify) CONTACT NAME; CONTACT PHONE:206-378-6613 JO PELLETT CONTACTEMAIL:HMCOORDINAIORS@V1?ASHfNGTONENERGY.CC)M A -EElKENT;''t hereby arlif)+#tizit;t have read Mid et-wined this application end know the same to be true and correct, Alf provisions of laws and ordinances gewarnfng,ttris • 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 298.200 WAG Ci. of Everett Official Use On! .: PER A' ,' 11/4/19 E \ 1- on Own rthorlxe.«, rrtStgnatureDate a ,.r _ _ , . . to .�� (Ra✓sad l/11f.7819) Page 1-Application