7121 HIGHLAND DR 2020-03-06 - Laserfiche WebLink

I ELECTRICAL PERMIT APPLICATION i E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 , wASHINGron ._. (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa,gav I www,everettwa,gov/permits V. 4d �� : , EcrEIntO RMATJ �Y a ' ;, : PROJECT ADDRESS: 7121 Highland D)(' BUILDING AREA: sq ft PROJECT_TYPE: 0 NEW,CONSTRUCTION ❑ADDITION, CI TENANT IMPROVMENT _0 REMODEL R BUILDING USE: ❑SFR ❑TOWNHOUSE D DUPLEX ❑ADU O MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL EMLRCTRIC L APPLICATtOAINFORMATION ESFRIPT1ON OFWORK _� = CONTRACT PRICE OF WORK:$ 350 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK. - FURNACE CHANGE OUT 1 HIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) r LINE VOLTAGE WORK? El NO ❑YES-Select Scope: ❑Service El Feeder ❑Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ®Thermostat ❑Audio ❑ Secure Access El Security System ~ ❑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. 1 o Other(List AID: , is THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: f NO ❑YES--See Below&Pg.2 EBy 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 t See Page 2 re4uire Plan Review_ ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®NO DYES-See Below&Pg.3. rPursuant 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. ''''''..L' ' i' tt;, ice' 'r;'''' l 1„;, t •,,„:;-!'<-7,. ,;1* _Y ,',TACT I',NNFORMyMATIP:tl'7:0�a :.... . , 1S,t,•+ OWNER NAME: Dorian Goettler TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7121Highland DrSE F _ _ CITY EVERETT STATE .wa_._. _... .....ZIP 88205 :- OWNER PHONE: 425 444 4743 OWNER EMAIL:_......oettler.famil •'.mail.com t. CONTRACTOR NAME: MM COMFORT SYSTEMS i CONTRACTOR ADDRESS: STREET 181Q3 NE 68TH ST S . C-200 CITY REDMOND STATE WA zip 98052 CONTRACTOR PHONE: 425-881-7920 !;CONTRACTOR EMAIL. PERMITS c@.MMCOMFORTSYSTEMS.COM CONTRACTOR LIC.*REQUIRED); O C: 814:m (CITY OF EVERETT BUSINESS LIC.#(REQUIRCD): 0.524 . MMS 1 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR DOTHER(Please Specify) CONTACT NAME; CONTACT PHONE: 4255.-529-1-025 Jenah Barlow CONTACT EMAIL: PERMITS@MMCOMFORTSYSTEMS.COM ,4pee4WE 1/T.:t hereby certify^that I' 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 1 am authorized by the owner of this property to perform the work for which application is made and I I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official.Use Onty .. l PERMIT#: ..j. I ''Z.( * .32.1D Esool-oo5 Owner Auth,tile 9 nt Signature Date (Revised ifi1/2019) Page't-Application 1