1716 96TH ST SW 2022-01-27 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION , CITY OF EVERETT PERMIT SERVICES 1 '__ 3200 CEDAR STREET,EVERETT,WA 98201 I (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I wwov.everettwa.gov/permits PROJECT ADDRESS: 1716 96TH ST SW BUILDING AREA: 1227 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT © REMODEL BUILDING USE: ©SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU LI MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ) 111z E.ECTRICAL,t OJTTION FORMA ICI*V M ETIO 'ORK .., . CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable);; DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR HEAT PUMP INSTALLATION -TSTAT 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 ❑ 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}: ; , 0-4 DE:COMPLIANCE , ''. 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 298-46B-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: IZINO EYES-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 ,. CONTACT INFO) TIO . ,, OWNER NAME: RODNEY CHELI US TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1716 96TH ST SW c, EVERETT STATE WA ziP 98204 ... ._ OWNER PHONE:425-348-6930 OWNER EMAIL:rgc2emc@frontier.com CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STReeT 1415 BROADWAY CITY 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): 016098 PRIMARY CONTACT: ❑OWNER I2ICONTRACTOR ❑OTHER(Please Specify) .— CONTACT NAME: CONTACT PHONE:425-259-0550 - KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM AGREEM N 7 /hereby ce t�ty that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 4type of work wilt 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/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 ` )�J y, ,-� / PERMIT#; / t C\f/-44'`.cY I%L{� /t/Cy 12/06/19 E .c 2, - (J(4 S Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application [ „, . y_