4824 COLLEGE AVE 2020-05-07 - Laserfiche WebLink

LILI ,.....ECTRICAL PERMIT APPLILtkTION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govipermits WASHINGTON 0:A :1 'EINFORMATION ^rte . PROJECT ADDRESS: 4824 College Ave BUILDING AREA: 1,390 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ® COMMERCIAL D ► AL APPLIC ",,. e., , "...a .:,..AT `( , ,: RPTION t WORK., ' CONTRACT PRICE OF WORK:$ 2000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Extending circuit adding an addition circuit undground to the shed 15 amp circuit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO El YES-Select Scope: El Service El Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? 0 NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access El 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. Cl Other(List All): CODE CO 1 I 7 IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: 0 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. OYES 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. wINFORmokrio.N OWNER NAME: Deena Backes TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET 4224 College Ave Cf7,. Everett STATE WA ZiP 98203 OWNER PHONE:425-783-0545 OWNER EMAIL:deenabackes@yahoo.com CONTRACTOR NAME: DEAR Electric Inc CONTRACTOR ADDRESS: sTREET19309 68th ave S R106 CM' Kent STATE WA Zip 98032 CONTRACTOR PHONE:2067357604 CONTRACTOR EMAIL:schedule@DEARServices.net CONTRACTOR LIC.#(REQUIRED):DEAREEI864PN ,CITY OF EVERETT BUSINESS LIC.#(REQUIRED): / (-16)3/ C PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-915-4121 Jazari Moore CONTACT EMAIL:Schedule@DEARServices.net 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 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 taw regulating const u'dtion or the perfa./dance 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 theState Contractors Law 19,27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ` ., . (: 11:, it22 . / �` V Owner uthor d ent Signature Da (Revised 1/11/2019) Page 1-Application /