10217 19TH AVE SE DR YAMAGUCHI 2022-12-30

• 1• ELECTRICAL PERMIT APPLICATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WA6M1 NGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsf everettwa.gov l www.everettwa gov/permits PROJECTS INFORMATION PROJECT ADDRESS: 10217 19th Ave SE, Everett,WA 98208 BUILDING AREA:N/A sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL .... ELECTRICAL APPLICATION INFORNIATIONADESCRIPTIONIOTANORKA, , `A: , CONTRACT PRICE OF WORK:$ 700 ASSOCIATED BUILDING PERMIT#(If applicable): N/A DESCRIBE SCOPE OF WORK: Replace existing roof top HVAC unit with new one. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO .]YES-Select Scope:❑Service ❑Feeder Q 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): • a _ 'CODE;CO. . IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILmES: ❑NO 0 YES—See Below&Pg.2 By checking this box,I am staling that I have read and understand all of WAC 296.46E-900,selected the specific reason on page 2 (v I 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:Ir INO OYES-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. CONTACTIINFORMATION .. "" OWNER NAME: 19th Ave Dental TENANT BUSINESS NAME(If Commercial): 19th Avenue Dental OWNER MAILING ADDRESS: allaseT 10271 19th Ave. SE cmr Everett STATE WA zw 98208 OWNER PHONE:(425) 385-8130 OWNER EMAIL:N/A CONTRACTOR NAME: Seahurst Electric, Inc. CONTRACTOR ADDRESS: sniEET2915 Chestnut St. c,rr Everett STATE WA zw 98201 CONTRACTOR PHONE:(425) 258-1882 (CONTRACTOR EMAILJf0VY@seahurst.com CONTRACTOR LIC.#(REQUIRED):SEAHUEl0990N CITY OF EVERETT BUSINESS LIC.#(REQUIRED):18763 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425)258-5143 Dave LeBlanc CONTACTEMAIL:dleblanc@seahurst.com AGREEMENT I hereby certify that I have read and examined this application and know the same to be true and correct. AA 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 violate or cancel the provisions of any other state or local 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 made and I comply with the Stale Contractors Law 18.2T RCW end 296,200 WAC. City of Everett Official Use Only PERMIT#:L-`1\`' f 8-1--19 E Q( - G,, OwnerlAuthoriz ent Signature Date (Revised 1/11/2019) Page 1-Application