5503 COLBY AVE 2020-05-05 - Laserfiche WebLink

E CTRICAL PERMIT APPLI TION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits 4ETT PROJECT° WI OR1AT O PROJECT ADDRESS: 5503 Colby Ave BUILDING AREA: sq ft PROJECT TYPE: ✓❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑✓ ADU ri MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL . ELE KCAL APP . CATION IINFORMATI lt.DESCR.IPTIO EBF WORK .. CONTRACT PRICE OF WORK:$ 5000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Additional dwelling unit. Small one bedroom THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ✓❑YES-Select Scope: 0 Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ 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): m .c: ..,.:.• �� `:.. .. :.:;CODE MPPA;., 2� '.. \..` �& says ii`3i[ y\\ ...:_ ..; ._�>.: , .,,tea \ _ _ _ _ _ ._.1, $-_� S ti5v.. S IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: LTJ NO LJ 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: ✓❑NO ❑YES-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. R- F . fii \i s \ N. \7..1' . t:,1q'� N O OO .. ..�... k. \ \ . , � \ NIO \ , ; OWNER NAME: Jeff Loup TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5503 Colby Ave ,^' CITY Everett STATE V VA ZIP 98203 OWNER PHONE:425-210-3486 OWNER EMAIL: CONTRACTOR NAME: Amped Electric and Mechanical LLC CONTRACTOR ADDRESS: STREET PO BOX 868 CITY Everett STATE WA ZIP 98206 CONTRACTOR PHONE: 360-294-8276 CONTRACTOR EMAIL: Info@ampedelectricllc.com CONTRACTOR LIC.#(REQUIRED):AMPED907DR CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 048712 PRIMARY CONTACT: El OWNER nCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4255310352 Mike V p V CONTACT EMAIL: AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Mike Walker 8/21/19 E I g ui, I Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application