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ktCTRICAL PERMIT APPLIATION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> * <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT ADDRESS: 7010 Yew St BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION Cl TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> l MSRL ' TR AL APPLI rr<" O 1N OR,MA, r,N r. . S4V:PTI O . OF 1mwtm, ` 'fz <br /> CONTRACT PRICE OF WORK:$ 350 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> FURNACE CHANGE OUT ADD AC <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO El YES-Select Scope: ❑ Service El Feeder ❑Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ®Thermostat ❑Audio ❑Secure Access El Security System <br /> ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> El Other(List All): <br /> k r ODE IgmP 1 NCI ,u g : € m <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ® NO ❑YES--See Below&Pg.2 <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ®NO DYES-See Below&Pg.3 <br /> nf 1 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> OWNER NAME: Richard&Cindy Davis TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7010 Yew St <br /> C17Y redmond STATE wa ZIP 98052 <br /> OWNER PHONE: 206 419 8471 OWNER EMAIL. .) ft <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 18103 NE 68TH ST SE. C-200 <br /> CITY REDMOND STATE WA ZIP 98052 <br /> CONTRACTOR PHONE: 425-881-7920 CONTRACTOR EMAIL: PERMITS@MMCOMFORTSYSTEMS.COM <br /> CONTRACTOR LIC.#(REQUIRED) MMcpMCS839PT CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 055245 <br /> PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4255-629-1025 <br /> Jenah Barlow CONTACT EMAIL: PERMITS@MMCOMFORTSYSTEMS.COM <br /> 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 <br /> 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 <br /> 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 <br /> comply wth the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> E ���� � 1�2 <br /> O er/ thori d Agen ignature 1 :\� <br /> PERMIT#: <br /> Date (Revised 1/11/2019) Page 1-Application <br />