725 RUCKER AVE 2019-07-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION / _ CITY OF EVERETT PERMIT SERVICES AV-44a, 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 725 Rucker Ave Everett 98201 BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATIONINFORMATION & DESCRIPTION of WORK CONTRACT PRICE OF WORK:$ 1800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Repalce Knob and Tube in attic and basement where accessible THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) UNE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope:❑Service El Feeder ❑✓ Circuits-#:5 ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑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 All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO El YES—See Below&Pg.2 ❑ By checking this box,I am stating that I have read and understand all of WAC 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 following sub sections that do not See Page 2 require Plan Review. ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ENO EYES-See Below&Pg.3 U 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. CONTACT INFORMATION OWNER NAME: Colby Mangini TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 725 Rucker AVE cm Everett STATE WA ZIP 98201 OWNER PHONE:na OWNER EMAIL:na CONTRACTOR NAME: In House Electrical Services,Inc. CONTRACTOR ADDRESS: STREET1530 117th DR SE cay Lake Stevens STATE WA z>P 98258 CONTRACTOR PHONE:4257603203 _CONTRACTOR EMAIL:ihepermits@gmail-com CONTRACTOR LIC.#(REOUIRED):inhoues952gg CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: [DOWNER 0✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257603203 Ise, CONTACT EMAIL:ihepermits@gmail.com AGREEMENT.I hereby•edify that have read rod examine•this application and know the same to be true and correct. Alt provisions of laws and ordinances governing this type of work ill be co rioted w ether spe ed herein or .1. Thr .ra ng of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law gulating co structb•or the p • ante of c., tnrct..n. T, t am authorized by the owner of this property to perform the work for which application is made and I comply wl h the State o. -: tors Law,:.27 RCW: • 9:2..W• City of Everett Official Use Only ( PERMIT#: 4(10((1 E \,°101-I - " 1 OwnerlAuthofized Agent Sign ttfre Date (Revised 1/11/2019) Page 1-Application Scanned with CamScanner