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EEECTRICAL PERMIT APPLIC TION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 5118 15th Ave W BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ] REMODEL
<br /> BUILDING USE: SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI FAMILY #OF UNITS: ❑COMMERCIAL
<br /> EIC. + ' Rlt�l APPL14�1TION INFO IVVAMON'& ESCR1PTION OF WORK ' v
<br /> CONTRACT PRICE OF WORK:$ 350. ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: /VL&Q c.ko &1-. CA-rt
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO Cl YES-Select Scope: ❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ®Thermostat ❑Audio ❑Secure Access ❑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 /> ❑Other(List All):
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<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 /> u 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO EYES-See Below&Pg.3
<br /> 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.
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<br /> OWNER NAME: Debby Burns TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 5118 15th Ave W
<br /> CITY redmond STATE wa ZIP 98052
<br /> OWNER PHONE: 2064462501 OWNER EMAIL: debbyyana@yahoo.com
<br /> CONTRACTOR NAME: MM COMFORT SYSTEMS
<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). I�,Q��OI�IJCS$,��PT CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 9 245
<br /> PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-629-1025
<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/am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> � S' i9 E10rOD
<br /> Owngr/q,ut ized Ag ignature Date (Revised 1/11/2019) Page 1-Application
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