610 COLBY AVE 2022-01-27 - Laserfiche WebLink

09/19/2019 08:58 94407 P.001/001 llllllllllr `i EVERETT ELECTRICAL. PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, FVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everettepsQeverettwa,gov I www,everottwa.gov/permits Wt *a•';L3iwi,:;br�!a PROJECT ADDRESS: 610 Colby Ave BUILDING AREA: sV ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓0 TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: Q SFR ❑ TOWNHOUSE ❑ DUPLEX D ADU ❑ MULTI -FAMILY - # OF UNITS: ✓n COMMERCIAL .•v/. ¢h�h�Sa4TibJ��"Yr.1 CONTRACT PRICE OF WORK: $ 750 ASSOCIATED BUILDING PERIiMIT # (if applicable): DESCRIBE SCOPE OF WORK: New Range Circuit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: ❑ Service ❑ Feeder R Circuits-* ❑ Complete Re -wire LOW VOLTAGE WORK? WNO ❑ YES- # of D6VICeS' SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Aeeass ❑ 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): 15 v....1.N.:,„Sf,.i..�'vkh'^Vi>a�,:1''+ �.: i o-. 'h r. , tt, ,J�„�•', �', `,k 5.. s'v.n,,. k..,..R i,,,:..., n7 w. {:•;t: RONNIE 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 296-468-900, selected the specific reason on page 2 El 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: ✓ Na YES -See Below & 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. OWNFR NAME: Nicholas/Robyn Roth TENANT RUSINI=SS NAME If Commercial): OWNER MAII-ING ADDRESS: STREET 610 Colby Ave c,, EVERETT STATE WA ZIP 98201 OWNER PHONE:425.870.2957 OWNER EMAIL: CONTRACTOR NAME_ EYLANDER SALES & SERVICE CONTRACTOR ADDRESS: sT1,3601 EVERETT AVE CITY EVERETT STATE WA nP 98201 CONTRACTOR PHONE:425.259.2161 1CONTRACTOR EMAIL:Jceylander@yahoo.com CONTRACTOR L1C. #(REQUIRED)=EYLANSS1421P CITY OF k4RETT BUSINESS LIC. #(REOUIRED): 016363 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER (Please Specify) CONTACT NAMF: corny 1 CONTACT PHONE:425.231.2275 CONTACT EMAIL:jceylander@yahoo.com st .,ur«cmCry : i nereoy cenay inar i nave laaa ana examwea finis application anti Know the same to be true and conbct. 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 viviate or cancel the provisions of any other state or focal 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 marls and I comply with the State Contractors Law 18,27 RCW and 296.200 WAC. Ca of Everett official use Onl Zi i% PERMIT #: Owner uihoria6d Agent Signature Dag (Revised 1/1 J/2099) Page 4-Application