4815 COLBY AVE 2022-01-27 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa,gov I www.everettwa.gov/permits •lY"'_ 7 7, - I 9�Rl M,9 # : SI 1{ E :Afll�fi QII�lE1R' T1O ,',, y�q y�y( ■yy; y■ �yy{ q■w, ■y y■yp ■ ��yV Why S�Ygq �Yy ;yam■ PROJECT ADDRESS: 4815 COLBY AVE BUILDING AREA: 1684 sq <.t PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT © REMODEL BUILDING USE: © SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL E't; li [Cl l !I LIC,r TION•tNFOR�ill� TION &DIM WTON OF WO CONTRACT PRICE OF WORK: $ 500 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: ADDING CIRCUIT FOR A/C INSTALLATION AND RELOCATING EXISTING FURNACE CIRCUIT ;TSTAT INSTALLATION AND CONNECTION THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY LINE VOLTAGE WORK? © NO ❑ YES - Select Scope: ❑ Service ❑ Feeder © Circuits-#: 2 ❑ Complete Re -wire LOW VOLTAGE WORK? ❑✓ NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom © Thermostat ❑ Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An addition�L, Fire Alarm Permit is required for review of device location and installation approval. ❑ Other (List All): CODR COMPLIANCE;,, IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 21 NO YES -- See Below &-Pg: 2- ❑ By checking this box, I am stating that I have read and understand all of WAC 296-468-900, 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: ✓ NO MYES -See Below 8 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. c.. NT,T:. F 11W, TIO OWNER NAME: BEN DANIELS TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: sraeEr 4815 COLBY AVE crrr EVERETT STATE WA Z,, 98203 OWNER PHONE: 425-417-2010 OWNER EMAIL: ben@benandcariy.com CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY cmr EVERE17 STATE WA zia 98201 CONTRACTOR PHONE:425-259-0550 1CONTRACTOR EMAIL: KAILANA@CMHEATING.COM CONTRACTOR LIC. #(REQUIRED): CMHEAMH877DN CITY OF EVERETT BUSINESS LIC. # REQUIRED : 016098 PRIMARY CONTACT: DOWNER. ©CONTRACTOR []OTHER (Please Specify) CONTACT NAME: KAI LANA CONTACT PHONE:425-259-0550 CONTACT EMAIL: KAILANA@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 specked 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 constructlon, That I am authorized by the owner of this property to perform the work for which application is made anrU comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Ci of Everett Official Use Only I PERMIT #: 1 ��tLl�/ Lc�f�ry1 11/15/19 aam= \O� uwnernAumonzea Agent Signature 4/� Date (Revised 1/11/2019) Page 1-Application 3 t }