1907 100TH ST SW 2020-02-25 - Laserfiche WebLink

vim tLECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION." PROJECT ADDRESS: 1907 100th St l 'Y OW BUILDING AREA: 800 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL • ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 750 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replace bathfan and switch 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 El 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. Cl Other(List All): CODE COMPLIANCE. 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 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. CONTACT INFORMATION OWNER NAME: Joyce Nicol TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1907 100th St N CITY Everett STATE WA zip 98204 OWNER PHONE:(425) 353-0844 OWNER EMAIL: N/A CONTRACTOR NAME: AC Electric Service CONTRACTOR ADDRESS: sTREET20012 35th Ave S CITY SeaTac STATE WA ZIP 98198 CONTRACTOR PHONE:206-779-3929 CONTRACTOR EMAIL:ac_electric_service@yahoo.corn CONTRACTOR LIC.#(REQUIRED):celecce873oz CITY OF EVERETT BUSINESS LIC.#(REQUIRED):57941 PRIMARY CONTACT: CI OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-779-3929 Alyne Hansen CONTACT EMAIL:ac_electric_service@yahoo.com AGREEMENT:I 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#: Alyne Hansen 12-18-19 E Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application