7004 BEVERLY BLVD 2021-11-10 - Laserfiche WebLink

• • ELECTRICAL PERMIT 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 I www.everettwa.gov/permits 4 .°„w _ f`°+ . -...„ ,„ , ,,T �e.a ' PROJE - NFORMATION Y,ti a „ . .x . . „ ,,,4 PROJECT ADDRESS: 7004 BEVERLY BLVD BUILDING AREA: 1920 Ift PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ©REMODEL BUILDING USE: ✓❑SFR ❑TOWNHOUSE ❑DUPLEX 0 ADU ❑ MULTI-FAMILY-#OF UNITS: E COMMERCIAL S", HIV ELE ICAL APPLICATION ,. `.. Al $C : .. s !,.. 9415... ...< = CONTRACT PRICE OF WORK:$ ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR DUCTLESS HEAT PUMP INSTALL THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑NO ❑YES-Select Scope: ❑ Service ❑Feeder ❑✓ Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio El 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [! 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:IZNO DYES-See Below&Pg. a — 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. ',. :-.."7 +yak *W!? d t. .CONTA „ 8,,..ex....AR - iON i,�,,;,,,,,yA, w,;.t3s ,.. .,. .. o :..��. 0..£g5f4.'.'• OWNER NAME: MAIYA ATKINS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7704 BEVERLY BLVD CITY EVERETT STATE WA ZIP 98203 OWNER PHONE:425-870-6939 OWNER EMAIL:MAIYAATKINS@MSN.COM CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY CRY EVERETT STATE WA ZIP 98201 ... CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CM HEATING.COM ` CONTRACTOR LIC.#(REQUIRED: CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED;,016098 PRIMARY CONTACT: DOWNER QCONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-259-0550 KAI LANA 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 -lrpe 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 Vocal law regulating construction or the performance of construction. Thal/am authorized by the owner of this property to perform the work for which application is made and/ mply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only ��Y,/��--�1' ) PERMIT#; �Y c /l+ 4 e sy 7 J1� W 08/28/19 E p r- \7 ,...__, Owner/Authorized Agent Signature Date (Revised f/11i O19) Page 1-Application j