6909 HIGHLAND DR 2023-06-16 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SEenGES EVERETT 3200 CEDAR STREET, EVERETT WA gS2nl (G) 425267d8101 t E) PermiSerecogettieverroomgovI rw.w evernervera govlpinnita PROJECT SITE INFORMATION PRWECTADDRESS I BUILDING AREA: egft PROUECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION '❑ TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX El ADD ❑MULTI -FAMILY -M OF UNITS:_ ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION A DESCRIPTION OF WORK CONTRACT PRICE OF WORK:S ASSOCIATED BUILDING PERMIT Y lit applicable)' DESCRIBE SCOPE OF WORK: Convert also dryer ckt to a disconnect running a split heat pump Outside. Convert elec dryer ckt to a disconnect running a split heat pump outside. Run 14/4 to head i believe this is 120V THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑YES - Select Smpa:❑Service ❑Feeder ❑Circuity i ❑Complain Rewire LOWVOLTAGEWORK? ONO DYESpof Devlcas:l SELECT SCOPE (REQUIRED):❑Data ❑Intercom ❑Thermostat El Audio ❑Secure Access ❑Security System ❑ Fire Alarm - Installations under this permit only include electrical wring rough -in of the system. An additional Fire Alarm Permit Is required for review of device location and Installation approval. ❑ Other (List Alp: CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: kJ NO LJ YES — See Below 8 Pg.2 ❑ By checking this box, I am slating that I have read and understand all of WAS 296-468-900, 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 fallowing sub sections Mat do not See Page require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: L!LJNO LJr ES -See Not 8 Pi ❑ Pursuant to RCW 19.28.261, Property owners and leaseholders cannot perform de a l work on buildings for rent, sale, or lease without the proper electrical licensing and cedi0cation, or exemption. By checking this box, I am staling that I have completed and See Page signed the AFFIDAVIT on page 8 of this application to receive exemption from this llcensinglcedifcation requirement. CONTACT INFORMATION OWNER NAME: Jason Shaver TENANT BUSINESS NAME fit Commercial: OWNER MAILING ADDRESS: immer 6909 Highland Dr m. Everett ATE WA z1.98203 OWNERPHONE: OWNER EMAIL: CONTRACTOR NAME: Mount Vernon Electric, LLC CONTRACTOR ADDRESS: goal 618 W. Hazel cm Mount Vernon S Are WA „a 98273 CONTRACTOR PHONE: 360 540 0996 CONTRACTOREMAIL bullhelfrer@hotmall.Com CONTRACTOR LIC. IREOUIFI MountVE93417 ICITY OF EVERETT BUSINESS LIC. REQUIRED: 60924 PRIMARYOONTAOT: DOWNER 'CONTRACTOR DOTTER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: bullheimerg@hotmail.com AGREEMENT I Mreby come Mat l he" man and evembretl free app'kal arm know Me Same b te fee are comxL Agpmvlalma of lam aM¢Mrranma gaveMnO Two fyyeo/vwk wAlbe mmpWJxlMbxapbMNMa'n n-noL TM pnnWpalepmd MwtMgearme bgiw wlMfiybvu4Kwunullbep'oraimadanyWMrMah wbaaNawmlWatingcmaWmm wMaperlmn+ntt olronWu[Mm. ilraflamaullpnuebyllre omrerolilvapopMybperlwm hire xaM1brxltivlr apphaNmume0.andl cwrryJy vnM th SIM LOMaclora lax fa2]RLW wm2R8.2MWAC C' of EvanX OlfiialVU On PERMIT%: 26MAY22 I E WnerlAumorlxM Agent signature Vale IRSVISed1/W]0xx) Page lJppllcmon