1609 ROCKEFELLER AVE 2021-04-01 - Laserfiche WebLink

ELECTRICAL PPRMIT & FIRE ALARM PE!MIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov l www.everettwa.gov/permits 4rErr PROJECT SITE INFORMATION PROJECT ADDRESS:1609 1/2 ROCKEFELLER AVE PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION LI TENANT IMPROVMENT ❑✓ REMODEL BUILDING USE: ✓❑ SFR ❑TOWNHOUSE ✓❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL BUILDING AREA: 1240 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $250 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑✓ NO ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? ✓❑ NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: LIKE IN KIND FURNACE CHANGE OUT IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓1NO EYES-See Below& Pg. 3 Pursuant to ROW 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: GWEN ANDERSON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1609 1/2 ROCKEFELLER AVE crr, EVERETT STATE WA ZIP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY crry EVERETT STATE WA zip 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL: DEBBIE@CMHEATING.COM CONTRACTOR LIC.#(REQUIRED):CMHEAMH877DN CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 016098 PRIMARY CONTACT: ❑OWNER Z CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-259-0550 D E B B I E CONTACT EMAIL:DEBBIE@CMHEATING.COM 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 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 ��ii�� // � // , PERMIT}# / Kd,,L�/tM NO/(/1 12/20/18 el ` Z — ❑ Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application