5118 23RD AVE W 2020-08-28 - Laserfiche WebLink

mu in ECTRICAL PERMIT APPLTION EVERETT V, CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits : W .�. 3.`7" UTE'INFORMATION PROJECT ADDRESS: 5118 23rd AVE W BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ✓❑TENANT IMPROVMENT El REMODEL ."IJILDING USE: 0SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: HEAT PUMP AND AIR HANDLER b l S 60kikKer y fl1(oi ou cr §-/C( nic/G, vt ap kkVticc 75171,1--7--- THIS INSTALLATION INCLUDES THE FOLLO ING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO P.T4 YES-Select Scope: ❑Service ❑Feeder 0 Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom 0 Thermostat ❑Audio El Secure Access ❑Security System El 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 y,y.; v� s,s;i a lLvus,.A i iviv,iiNS i i't JTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: DNO El YES See Below&Pg.2 n1 1 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO DYES-See Below&Pg.3 flI Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I 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. CONTACT INFORMATION OWNER NAME: BARBARA KELLEY TENANT BUSINESS NAME(If Commercial): /W f q 97 -p g 1 OWNER MAILING ADDRESS: STREET 5118 23RD AVE W CITY EVERETT STATE WA Zip 98203 OWNER PHONE:425.405.3071 OWNER EMAIL: CONTRACTOR NAME: EYLANDEER SALES & SERVICE CONTRACTOR ADDRESS: STREET3601 EVERETT AVE cry EVERETT STATE WA Zip 98201 CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL:1Ceylafder@yahOO.CORI CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:CO RNY 1 CONTACT PHONE:425.231.2275 CONTACT EMAIL: AGREEMENT'I hereby certify that/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 wit t State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ,/�� //�/7' E ig6i • OSb O,'er/Au o •• •ent Signature Date ! (Revised 1/11/2019) Page 1-Application