1104 39TH ST 2019-08-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION ,. CITY OF EVERETT PERMIT SERVICES *Ill - 1 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT°;SITE INFORMATION. PROJECT ADDRESS: 1104 39TH ST (3901 NASSAU ST) BUILDING AREA: 1950 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT © REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL �' RLE T TICAL APPU A"TION IINFOR A IiO '& DESCR ` 'ICN OF WORK CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD CIRCUIT FOR HEAT PUMP INSTALLATION - TSTAT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑Service ❑ Feeder 0 Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El 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): r : - _ " CODE COMPUANCTI IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓l NO ❑YES--See Below&Pg.2 Q 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: 71 NO EYES-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. -` CONTACT ORMATION .y ,, (OWNER NAME: DANIEL THOMPSON TENANT BUSINESS NAME(If Commercial): -- OWNER MAILING ADDRESS: STREET 1104 39TH ST(3901 NASSAU ST) CITY EVERETT STATE WA ZIP 98201 OWNER PHONE:360-649-5872 OWNER EMAIL:dht7nllle@yah0O.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: CMHEAMH877DN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 016098 PRIMARY CONTACT: EOWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: KAI LANA CONTACT PHONE:425-259-0550 CONTACT EMAIL:KAILANA@CMHEATING.COM ADREEMEN.T 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 l ae authorized by the owner of this property to perform the work for which application is made and l ( comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: r Y Y Y 1`,1, ,41 04/17/19 E ` co� L,(_,k Owner/Authorized Agent Signature s Date '(Revised 1/11/2419) Page 1•Application 9