118 79TH PL SE 2019-08-14 - 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PRS i ...;,:,•• OC $ ',. •. PROJECT ADDRESS: 1 18 79th PI SE 1BUILDING AREA: 1433 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT © REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL APPLICATION INtORNATIOfilIV,1511E CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): M1903-060 DESCRIBE SCOPE OF WORK: 7 -40AMP Dedicated Circuit for Heat Pump THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO E YES-Select Scope: ❑Service ❑Feeder ✓❑Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑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. El Other(List All): 0000",004 .C,:, � IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 7 NO i_1 YES--See Below&Pg.2 Ini I 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: tv=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. OWNER NAME: AJ Midkiff TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 118 79th PI SE CITY Everett STATE WA Zip 98203 OWNER PHONE:4253193015 OWNER EMAIL:Midkiff744@gmail.com CONTRACTOR NAME: SEATOWN ELECTRIC CORP. CONTRACTOR ADDRESS: STREET 3431 Broadway CITY Everett STATE WA Z,p 98201 CONTRACTOR PHONE:2069054946 CONTRACTOR EMAIL:permits@seatownservices.com CONTRACTOR LIC.#(REQUIRED):SEATOEC86ORB CITY OF EVERETT BUSINESS LIC.#(REQUIRED):53916 PRIMARY CONTACT: DOWNER • ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2069054946 Beka h Swanson CONTACT EMAIL:permits@seatownservices.com AGREEMENT:f hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of)aws 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 I am authorized by the owner of this property 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 PERMIT#: "• E AO)- 3/18/19 Owner/ o•zed Agent Signature Date p (Devised 1/11I2O19) Page 1-Application