4310 COLBY AVE 2019-03-14 - Laserfiche WebLink

Feb 22 19 10:28a Tom@CTR Elec^ 11 861839 p.1 #477ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE-INFORMATION • PROJECT ADDRESS: 4310 Colby Ave BUILDING AREA: ??? sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT REMODEL • BUILDING USE: El SFR El TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 2860.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: disconnect old & reconnect new cooling tower THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope: ❑ Service ❑Feeder ❑✓ Circuits-#:3 El Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom El Thermostat ❑Audio El Secure Access ❑ Security System El 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 Ali): "CODE.COMPLIANCE . . IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ID NO CI YES See Below&Pg.2 L I 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL UCENSURE: ENO DYES-See Below&Pg.3 7 I Pursuant to ROW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease f 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 INFORMATION OWNER NAME: Colby Medical TENANT BUSINESS NAME(If Commercial):Colby Medical Bldg OWNER MAILING ADDRESS: STREET CITY STATE zip OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CTR Electric Inc. CONTRACTOR ADDRESS: STREET P 0 Box 7475 cin, Kent STATE Wa U 14 zip 90842 CONTRACTOR PHONE:2533500966 CONTRACTOR EMAIL:Ctray@integrity.corn 41'G51 CONTRACTOR LIC.#(REQUIRED):ctrelI 07700 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):????� PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2533500966 Tom Ray CONTACT EMAIL:ctray@integrity.com 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 wit be completed whether specified herein or not. The granting ofa 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 f em 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 RCWand 296.200 WAC. City of Everett Official Use Only PERMIT#: /+ CT Ray 02-22-2019 E 'q Li�.� w (0 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application