2920 49TH ST SW 2022-03-04 - Laserfiche WebLink

... • 0 ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2920 49th St SW BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE El DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 6500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: A/C 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): CODE 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 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. ENO ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: E 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. I. ONTACT INFORMATION - OWNER NAME: Ken Wolf TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2920 49th St SW CITY Everett STATE WA ZIP 98203 OWNER PHONE:630-546-1342 OWNER EMAIL: CONTRACTOR NAME: Black Lion HVAC CONTRACTOR ADDRESS: STREET 11001 118TH PL NE CITY KIRKLAND STATE WA ZIP 98033 CONTRACTOR PHONE:425-814-3944 CONTRACTOR EMAIL:brenda p@blacklionhvac.COr CONTRACTOR LIC.#(REQUIRED):blacklh873gq CITY OF EVERETT BUSINESS LIC.#(REQUIRED):053541 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-814-3944 brenda CONTACT EMAIL:brenda@blacklionhvac.com 'AGREEMENT:t homey certify that I have read and examined this application end know the same to be true and correct All provisions of laws and a+dmances governing this type of work will /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 pia structon 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 wi'M p State antra rs L. 18,27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 3 E °I 6/14/2019 Own uthor d nt Si store Date (Revised 1/11/2019) Page 1-Application