10116 29TH AVE SE 2019-08-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I CE)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10116 29th AVE SE Everett 98208 (BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT 0 REMODEL BUILDING USE: SFR El TOWNHOUSE El DUPLEX El ADU C MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL APPLICATION INFORMATION& DESCRIPTION OF WORK:''... . CONTRACT PRICE OF WORK:$ 1800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 60 am hot tub circuit and 20 amp circuit for service receptacle THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO YES-Select Scope:❑Service 0 Feeder El Circuits-#:2 El Complete Re-wire LOW VOLTAGE WORK? ❑NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data []Intercom ❑Thermostat ❑Audio ❑Secure Access El 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 296-46B-900,selected the specific reason on page 2 of this application(see next page),AND Plan Review is NOT requirec 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 OYES-See Below&Pg.3 C 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. „ . .,a_ .. .'NTACT`INFORMA.TION M2, OWNER NAME:Bob Bagley TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10116 29th AVE SE ary Everett STATE wa zip 98208 OWNER PHONE:na ow.r." CONTRACTOR NAME: In House Electric CONTRACTOR ADDRESS: STREET1530 117th DR SE CITY lake stevens STATE wa zip 98258 CONTRACTOR PHONE:4257603203 coNTRAILihepermits@gmail.com CONTRACTOR LIC.#(REQUIRED):inhoues952gg CITY OF EVIERETT BUSINESS LIC.#(REQUIRED):044168 PRIMARY CONTACT: El OWNER []✓CONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:42576021203 kelsey CONTACT EMAIL:ihepermits( gmail.com 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 governing this type of work will be completed whether specified herein or not. The granting of a permit does not presu we 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! comply with the St.a Contractors Law 18:27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /5//7 E D1'\ • ner/A orized Agent Signature Date (Revised 1/11/2019) Page 1-Application Scanned with CamScanner