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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 FAX 425-257-8857 1(E)eveleiiePs@everettwagov 1 wiwr.everettwa.gov/permits
<br /> 1' PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: 1505 Silver Lake Rd BUILDING AREA: sq ft
<br /> PROJECT TYPE: Li NEW CONSTRUCTION El ADDITION Li TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 121 SFR El TOWNHOUSE El DUPLEX E]ADU 1:1 MULTI-FAMILY-#OF UNITS: El COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 3310.00 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Replace existing gas furnace with new gas furnace in same location, connecting to existing electrical.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO El YES-Select Scope:El Service El Feeder El Circuits-#: 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? 0 NO 121 YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data 0 Intercom Thermostat 0 Audio El Secure Access El Security System
<br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval,
<br /> 121 Other(List All):Connect new furnace electrical to existing electrical.
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDJOR PERSONAL CARE FACILITIES: NO C]YES--See Below&Pg.2
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<br /> See Page 2 require Plan Review,
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:[ZINO EYES-See Below&Pg.3
<br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> without the proper electrical licensing and certification,or exemption.By checking this box, I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
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<br /> OWNER NAME: Daniela Bojica TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1505 Silver Lake Rd
<br /> c,ry Everett si,„,„WA zip 98208
<br /> OWNER PHONE:206-255-9465 OWNER EMAIL:
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<br /> CONTRACTOR NAME: Day and Nite Plumbing and Heating
<br /> CONTRACTOR ADDRESS: STREET 16614 13th Ave W
<br /> CITY Lynnwood STATE WA , 98037
<br /> CONTRACTOR PHONE:425-775-6464 CONTRACTOR EMAIL:bryan@dayandnite.net
<br /> CONTRACTOR LIC.#(REOUIRED):DAYNIPH944R0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):019741
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<br /> PRIMARY CONTACT: [DOWNER 000NTRACTOR OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-255-9465
<br /> Daniela CONTACT EMAIL:
<br /> AGREEMENT:/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
<br /> type of work will be completed whether speckled 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
<br /> local law regulating construction or the performance of construction. That lam authorized by the owner of this properly to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only
<br /> PERMIT#:
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<br /> *woe uthorized Agent Signs e Date (Revised till/2019) Page 1-Application
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