6922 LOWER RIDGE RD 2021-12-10 - Laserfiche WebLink

001. 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 PROJECT SITE INFORMATION a. PROJECT ADDRESS: 6922 LOWER RIDGE RD BUILDING AREA: 1232 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT © REMODEL •1 BUILDING USE: ©SFR Cl TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ` ., ,,ELECTRicAL PPLICJ TION INFORMATION St:OR CRIPTIONOFANORI - CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR HEAT PUMP INSTALLATION THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: Cl Service El Feeder ❑Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? © NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ©Thermostat ❑Audio El Secure Access ❑ Security 9jisteie 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): CCIIR:COMPLIACE %�. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO E YES--See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-466-900,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: ENO ❑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 I without the proper electrical licensing and certification,or exemption.By checking this box,1 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% . ...' jCAIhI`I ACT II PC►I''MATION4, OWNER NAME: INA JOHNSON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 6922 LOWER RIDGE RD crrY EVERETT STATE WA zip 98203 OWNER PHONE:206-851-7378 OWNER EMAIL:inaj1263@gmail.com CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY cm EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM CONTRACTOR LIC.#(REQUIRED): CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED); 018098 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-259-0550 KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM 'AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this t ;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 regulatIn oastructfon 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 ale Contractors Law 18.27 RCW and 296.200 WAC. Ct of Everett Official Use Ow i' PERMIT#: 12/10/19 E l l OwnerlAuthortzed-AgentSignature' \ Date (Revised 1111/2019) Page 1-Application