4119 GRAND AVE 2020-03-06 - Laserfiche WebLink

aim Bra ELECTRICAL PERMIT APPLICATION • E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (F)425-257.8810 ) FAX 425-257-8857 I(E)everetteps@everettwa.gov l v:ww.evorettwa.govtpermils PROJECT SITE INFORMATION PROJECT ADDRESS: 4119 Grand Ave Everett 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT []REMODEL BUILDING USE: D SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION&DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (2)20 amp circuits to shed THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO tr t YES-Select Scope:0 Service O Feeder []✓ Circuits-#:2 El Complete Re-wire LOW VOLTAGE WORK? NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom O Thermostat O Audio 0 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): CODE COMPLIANCE !' k Cl E !, IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LJ 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: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. OWNER NAME:Jennifer St. Mary TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4119 Grand Ave cn,, Everett STATE WA z„98201 OWNER PHONE:na OWNER EMAIL:na CONTRACTOR NAME: in House Electric CONTRACTOR ADDRESS: STREET1530 117th DR SE cm' Lake Stevens STATE WA 2„98201 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:ihepermits@gmaii.com CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 ke I s ey (CONTACT EMAIL:kelsey@inhoUseelectric.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. At provisions of laws and ordinances governing this type of work wilt be completed whether specili:. •Broin or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of arty other state or local law reguta'•-constru '.n or the p:•.rma o of construction. That!em authorized by the owner of this property to perform the work for which application is made end comply wit e St to C. ractors La 18.27- W end 296.200 WAD. City of Everett Official Use Only PERMIT#: 40(724/ EO - o \- Owner!'uthorized Agent Signatur.� Date (Revised 1111/2019) I Page 1-Application Scanned with CamScanner