5403 COLBY AVE 2025-01-14 - Laserfiche WebLink

NEN litCTRICAL PERMIT APPLIIO4TION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 wacN Nr.T 7e (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 5403 Colby, Everett WA 98201 BUILDING AREA: Lower level-1171 sq ft PROJECT TYPE: _ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT LI REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ✓❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION 'DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 2500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Remove existing lower level duplex circuits(4-5) Remove knob and tube wiring associated with these circuits.Rework two circuits to accommodate perimeter power or as needed. install new 110v smoke/detector(or battery) Maintain existing electric Heat. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO CI YES-Select Scope: El Service ❑ Feeder I'�I Circuits-#: 2 ❑ Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): — Data ❑ Intercom ❑ Thermostat ❑ Audio u 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 " 17 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO ❑YES-See Below&Pg. 3 J 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. fJ CONTACTI.FORMATu' I" OWNER NAME: Accommodations Northwest TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET PO Box 595 CITY Edmonds STATE WA ZIP 98020 OWNER PHONE: 425.328.5158 OWNER EMAIL: burchcambers@yahoo.com CONTRACTOR NAME: work shall be completed by owner CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ✓❑OWNER [—CONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-328-5158 Burch Cambers CONTACT EMAIL: AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All 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 State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only PERMIT • Jeffrey C.Sellentin,Owner Agent o cf)2.- 0 0 4 2-5-2020 Owner/Aut on d g Signature Date (Revised 1/11/2019) Page 1-Application 3