10507 29TH AVE SE 2019-08-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 477CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps®everettwa.gov I www.everettwa.govlpermits .PROJECT SITE INFORMATION PROJECT ADDRESS: 10507 29th Ave SE BUILDING AREA: sq ft PROJECT TYPE ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IiVIPROVMENT ❑ REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: © COMMERCIAL ELECTRICAL APPLICATION INFORMATION A DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 800.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: connect new AC add on to existing electrical THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO ❑YES-Select Scope:0 Service 0 Feeder ❑Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices:1 SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access 0 Security System 0 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. 0 Other(List All):connect new AC add on to existing electrical CODE.COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO U 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO ❑YES-See Below&Pg.3 ❑ 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. .. ......... ... ... .. . . . ... . . . . .. 0ONTACT INFORMATION... OWNER NAME: Alissa Sells TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10507 29th Ave SW aTy Everett STATE WA ZIP 98208 OWNER PHONE:(425)239-0458 (OWNER EMAIL: CONTRACTOR NAME: Greenwood Heating&AC CONTRACTOR ADDRESS: STREET 825 S Stacy ST CITY Seattle STATE WA Zip 98134 CONTRACTOR PHONE:(206)784-1818 CONTRACTOR EMAIL:permits@greenwoodheating.com CONTRACTOR LIC.#{REQUIRED}:GREENHA922U7 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):043985 PRIMARY CONTACT: DOWNER OCONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(208)784-1818 Greenwood Heating &AC CONTACT EMAIL:permits©greenwoodheating.com AGREEMENT:t hereby certify that t have read and examined this application and know the same to be hue and correct. All provisions of taws 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 or local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work far which application is made and 1 comply with the State Con dors Law 18.27 RCW end296,200 WAC. City of Everett Official Use Only PERMIT#: • 61712019 E 1406r05- Owner/Auth rized Agent signature Date (Revised 1/11/2019) Page 1-Application