9727 18TH AVE W B203 2019-11-13 - Laserfiche WebLink

lilliPt ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwagov/permits 7' ''':::::7'INKAIECT SITE INFORMATION PROJECT ADDRESS: 9727 18TH AVE W UNIT B203 BUILDING AREA: 797 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ✓❑MULTI-FAMILY-#OF UNITS:143 ❑COMMERCIAL rll'',' ,..aa: * I ,, ',PLICATION,INFORMATION &D . CRI T OMF WORK CONTRACT PRICE OF WORK: $ 250 ASSOCIATED BUILDING PERMIT#(if applicable). DESCRIBE SCOPE OF WORK: 'ADD CIRCUIT FOR DUCTLESS HEAT PUMP INSTALL . THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO El YES-Select Scope:Cl Service ❑Feeder ❑ Circuits-#: 1 ❑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): Irc„),ONT S THIS PERMIt" '4,71',.0.F!'_:;, �.� ��.��....... 'CODE COMPLIANCE- T EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 71N011 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: NO EYES-See Below&Pg 3 r- 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. . 4 _"N ,. ;;, r ON1 A "I I R ON , 5. ., F MATI � OWNER NAME: CONNIE DUBOIS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 9727 18TH AVE W UNIT 8203 cin EVERETT STATE WA ZIP 98204 'OWNER PHONE:206-225-9292 OWNER EMAIL:doobwa@outlook.com CONTRACTOR NAME: C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY CITY EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL: CONTRACTOR LIC.#REQUIRED): CMHEAMH 877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED); 016098 PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425 259 0550 KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM AGREEMENT.t hereby certify that 1 have read and examined this application and know the same to be true and correct. At/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 u' `local law regulating construction or the performance of construction. That I am authorized by the owner of this properly 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 // � , ,ti PERMIT#: , C'~ ,�.•�'Y/t/, 711,(9/1./101_V 05/02/19 E 1 e` V' �J '" Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1•Appiication y