620 112TH ST SE SPACE 326 2020-02-25

SEP-23-2019 15:46 From:Arlington-Electric 360+435+6970 To:14252578857 Page:1/2 IN ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 J(E)overottopseeveretiwa.gov I www.everettwe.gcv/permits .,.: , . .. .. . : . PROJECT SITE:INF:ORMATi014.` _ . •,• r :.R !!%-.. r._ PROJECT ADDRESS: 620 112th Street SE, #326 Lago Plata MH !BUILDING AREA: .. sq ft PROJECT TYPE: ✓0 NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE; ❑r SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL,APPLICATION'INFORMATION&;,DES'CRIPTION'OF:WORK. ;, . ., CONTRACT PRICE OF WORK:$ $3,500 ASSOCIATED BUILDING PERMIT#(if applicable): C1907-004 DESCRIBE SCOPE OF WORK: Mobile home feeder to exisitng service and crossover hook up for mobile home 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? 0 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio El Secure Access 0 Security System 0 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): .'. •...,:..1..,.., :. +:. a. • • .... . .DEE E°'" rF ,, ,: MP.LIAN,C .. . .. 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(sea 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO 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 an exemption from this licensing/certification requirement. .•. ..... . . . . . .. :.:'1, .: _.'.R . .CONTACT:INFORMATION. 2... .w.... 2. . . . .. ... .:R i R: . OWNER NAME: Charlene and Jackie Chinn TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2126 99th St SE err„ Everett STATE WA ZIP 98208 OWNER PHONE:206-300-1804 OWNER EMAIL:charleenchinn@gmail.com CONTRACTOR NAME: Arlington Electric, Inc. CONTRACTOR ADDRESS: sl-Reel-13310 240th Street NE env Arlington STATE WA Z,P 98223 CONTRACTOR PHONE:36O-4O3-0515 CONTRACTOR EMAIL:artingtonelectric@msn.com CONTRACTOR LIC.#(REQUIRED):Arlinel833QN !CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 32404 PRIMARY CONTACT: [DOWNER E CONTRACTOR ['OTHER(Please Specify) _ CONTACT NAME: CONTACT PHONE:360-403-0515 Russ Tilton CONTACT EMAIL:arlingtonelectric t©msn.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 thl 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 canto!the proVlslone Of any other state or local law regulating construction or the performance of construction. That lam authorized by the owner of this properly to perform the work for which application Is made and I comply with the Slate Contractors Lbw 18,27 RCW end 295.200 WAC. City of Everett Official Use Only PERMIT#: r ipo c0Wner uthori=od Ag nt Signature Date (Revised 1/11/2019) Page 1-Application