4403 RIDGEMONT DR 2019-04-29 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION °I4`""" 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.SITEi;INFORMATION . t: e, PROJECT ADDRESS: 4403 Ridgemont Drive BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAAAPPLIG ':,,4„,,,1,:x i;',_.SAT CII~[ A°Dm`,,,_CRll rrio OF WORK ..... CONTRACT PRICE OF WORK:$ 700.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: circuit for fireplace THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ®YES-Select Scope: ❑Service ❑ Feeder ©Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? .❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio ❑ 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 All): COD!GOMPLIIA I 1 IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO In 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: ONO 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. it t q ;01F ' � OWNER NAME:Mark Olson TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREET4403 Ridgemont Drive CITY Everett STATE WA ,,,98203 OWNER PHONE: 425) 280-4887 OWNER EMAIL: CONTRACTOR NAME: switch Electric CONTRACTOR ADDRESS: STREET 7226 139th Ave NE CITY STATE Stevens STATE WA ZIP 98258 425-244-5511 service@myswitchelectric.com CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):SWI I(JEL91 I- K CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 05255/ PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-376-7662 Tiffany Erickson CONTACT EMAIL:tiffany@myswitchelectric.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 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 WAC. City of Everett Official Use Only gPERMIT#: L _ 2/22/19 E I M t2 D Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application