12031 14TH DR SE 2020-08-28 - Laserfiche WebLink

NNE I ECTRICAL PERMIT APPL kTION 1011`5-(10-1 EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps(aeverettwa.gov I www.everettwa.gov/permits INFORMATION _. PROJECT ADDRESS: 12031 14th Drive SE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU Li MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL TON INFORMATION & DESCRIPTIO CONTRACT PRICE OF WORK: $ 12,089 !`ASSOCIATED BUILDING PERMIT#(if applicable): M1910-067 DESCRIBE SCOPE OF WORK: Install (3) circuits for installation of natural gas furnace and air conditioner THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO y�YES-Select Scope: CI Service ❑ Feeder ❑ Circuits-#: _ ❑ Complete Re-wire LOW VOLTAGE WORK? CI NO L_7 YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom l 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): CODE.COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓I NO l 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: IJNO EYES-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. OWNER NAME: Kyle & Rachel Campo TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 12031 14th Drive SE CITY Everett SFA E WA ZIP 98208 OWNER PHONE:425-891-1959 OWNER EMAIL:NSA CONTRACTOR NAME: Barron Heating CONTRACTOR ADDRESS: STREET51 00 Pacific Hwy #103 CITY Ferndale STATE WA ZIP 98248 CONTRACTOR PHONE:360-676-11 31 CONTRACTOR EMAIL:kaylissad@barronheating.COm CONTRACTOR LIC.#(REQUIRED):BARROHA179D7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):052470 PRIMARY CONTACT: ❑OWNER W(CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-676-1 1 31 Kaylissa Dunmore CONTACT EMAIL:kaylissad©barronheating.com 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! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: g 1°11% VI E ' ic"\VD .1q3 Owner/Auth.rized Agent Signature Date (Revised 1/11/2019) Page 1-Application