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ELECTRICAL PaMIT & FIRE ALARM PE IIIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> k.4"7- <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:2502 VIRGINIA AVE <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL <br /> BUILDING USE: ✓❑SFR ❑ TOWNHOUSE E DUPLEX E ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> BUILDING AREA: 2474 sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $250 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? ❑✓ NO ❑YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? ✓❑ NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: LIKE IN KIND GAS FURNACE CHANGE OUT <br /> IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7 N 17I YES--See Below& Pg. 2 <br /> ❑ 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO 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 without <br /> the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: ED PARKER TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET2502 VIRGINIA AVE <br /> cin EVERETT STATE WA Zip 98201 <br /> OWNER PHONE:425493-7028 OWNER EMAIL:ep23@uw.edu <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> CITY EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA©CMHEATING.COM <br /> CONTRACTOR LIC.#(REQUIRED):CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016098 <br /> PRIMARY CONTACT: Cl OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> AGREEMENT.I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances <br /> 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 <br /> 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 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> i / /�I ���/� / PERMIT# <br /> / .44,L�////,cY 7-i-zo/tAiy 03/06/19 '' I q 0 - 0 (� <br /> Owner/Authorized Agent Signature v Date (Revised 11/5/2018) Page 1-Application <br />