4122 GRAND AVE 2020-03-06 - Laserfiche WebLink

um `; ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 { FAX 425-257-8857 I(E)overotteps@everotlwa,gav I www,overeltwa,gov/permits iI PROJECT SITE INFORMATION PROJECT ADDRESS: 4122 Grand AVE Everett WA 98203 BUILDING AREA: sq ft 1 PROJECT TYPE: ❑NEW CONSTRUCTION Cl ADDITION ❑TENANT IMPROVMENT 0 REMODEL 4 BUILDING USE: 0 SFR El TOWNHOUSE 0 DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK :, CONTRACT PRICE OF WORK:$ 5000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 4,1 200 amp panel change, rewire master bedroom and 2nd bedroom, (2) 15 amp circuits, exterioir conduit, ;4r new baseboard heater THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope:❑✓ Service ❑Feeder ❑Circuits-#:4 ❑Complete Re-wire 4;; LOW VOLTAGE WORK? ❑NO 0 YES-#of Devices: _ SELECT SCOPE(REQUIRED): El Data ❑Intercom ' ( ) ❑Thermostat ❑Audio ❑Secure Access CI System t.---- Ei ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional I» Fire Alarm Permit Is required for review of device location and Installation approval. FF tom;%r^ ❑Other(List All): CODE COMPLIANCE _,' IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILTIES: L_1INO ❑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 " 714 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO OYES-See Below&Pg.3 C 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:Tracy Montanez TENANT BUSINESS NAME(If Commercial): t OWNER MAILING ADDRESS: SWEET 4122 Grand AVE w Gm Everett STATE WA ,,,,98203 OWNER PHONE:11a OWNER EMAIL:na ryt P.-; CONTRACTOR NAME: In House Electric ',l', .y CONTRACTOR ADDRESS: STREET1530 117TH DR SE crry Lake Stevens STATE WA ZIP 98258 f'': CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:IHEPERMITS@GMAIL.COM :,f 4: CONTRACTOR LIC.#(REOUIRED):INHOUES952QG CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER ['CONTRACTOR DOTHER(Please Specify) 4$' CONTACT NAME: CONTACT PHONE:4257603203 KELSEY CONTACT EMAIL:kelsey@inhouseelectric.com AGREEMENT:I hereby cerfrfy that/have road and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this typo 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 reg .ling construction orf .e .mance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I vii comply vitt the State Contracto - trw 18.. RCW and 296.200 WAC. City of Everett Official Use Only ; / PERMIT#: �^ 11/i(/q E � ..�cik 02_? , iwnerlAu orized •rent Signature Date (Revised 111112019) Page 1-Application Scanned with CamScanner