1010 LOMBARD AVE 2019-03-28 - Laserfiche WebLink

ECTRICAL PERMIT APPLiti ATION $1vErr. CITY OF EVERETT PERMIT SERVICES' 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT ADDRESS: 1010 Lombard Ave Everett, WA 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑✓ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: El COMMERCIAL CONTRACT PRICE OF WORK: $ 800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replace 10 switches and 10 receptacles (4 altered circuits) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO El YES-Select Scope: El Service El Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio El Secure Access El 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. El Other(List All): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: l� NO I� YES--See Below&Pg.2 nI 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 LICENSURE: •NO 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. OWNER NAME: Frank Snare TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1010 Lombard Ave cry Everett STATE WA ZIP 98201 OWNER PHONE:4253467727 OWNER EMAIL:na CONTRACTOR NAME: In House Electrical Services, Inc. CONTRACTOR ADDRESS: STREET1530 117th DR SE CITY Lake Stevens STATE WA ZIP 98258 CONTRACTOR PHONE:4257603203 CONTRACTOR EMAIL:ihepermits@gmail.com CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4255307975 Kelsey CONTACT EMAIL:ihepermits@gmail.com AGREEMENT:I hereby certify that I have read.-•examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this type of work will be completed whet.- pe -• 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 _.lating construction' the pe.orma ce of con ction. That I am authorized by the owner of this property to perform the work for which application is made and I comp/, with t,e State Contr.ct.rs Law :.27 - W and 296. 00 WAC. City of Everett Official Use Only PERMIT#: , ///'7 Eit16 ' tP) Owne/Authorized A,-nt Signature Date (Revised 1/11/2019) Page 1-Application