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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> - 3200 CEDAR STREET,EVERETT,WA 98201
<br /> 1uy �y', (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I w{nw.everettwa,gov/permits
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<br /> .k..,. . , A,.•, . ing .,.;;� { ,:.4Ft, PROJECT SITE INFORMAx"g ,,,,jd�; , a s
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<br /> PROJECT ADDRESS: 4731 CARLTON RD BUILDING AREA: 1654 Iq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: El SFR ❑TOWNHOUSE ❑DUPLEX E ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 6724.15 'ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE & RELOCATE 200 AMP PANEL, REPLACE & RELOCATE FUSE PANEL FROM STAIRWELL
<br /> TO OUTSIDE.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO 0 YES-Select Scope: d Service ❑Feeder El Circuits-#: ❑Complete Fe-wire
<br /> LOW VOLTAGE WORK? El NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom []Thermostat El Audio ❑Secure Access 0 Security System
<br /> Fire Alarm-Installations under this permit only include electrical wiring tough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> ❑Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO II YES-See Below&Pg.2
<br /> 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
<br /> v ( of this application(see next page),AND Plan Review is NOT required because 1 meet all of the following sub sections thatlao not
<br /> See Page 2 require Plan Review, ED
<br /> NO YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: LvlNO ❑YES-See Below&Pg.3
<br /> V71Pursuantto RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or I ase
<br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have complete and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
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<br /> OWNER NAME: DANIEL ARNOLD TENANT BUSINESS NAME(If Commercial): oma_
<br /> OWNER MAILING ADDRESS: sTReer 4731 CARLTON
<br /> crrr EVERETT STATE WA zip 98203
<br /> OWNER PHONE:305-498-4066 OWNER EMAIL:DAN ARNOLD@LIVE.COM
<br /> CONTRACTOR NAME: GS HEATING, COOLING&ELECTRICAL LLC
<br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE
<br /> CITY EVERFr-T-�____.�___....___.... ._.. s�:,^`WA---_- ZIP 98201
<br /> CONTRACTOR PHONE:425-610-4257 +ONTRACTOR EMAIL:SARA@GSHEATING.COM
<br /> CONTRACTOR LIC.#REQUIRED):GSHEAI-IC6218R "FTy.OF EVERETT I JSINESS LIC.#(REQUIRED)•60058
<br /> 'PRIMARY CONTACT: [DOWNER [2JCONTRACTOR LOTHER(Please Specify)
<br /> CONTACT NAME: f CONTACT PHONE:425 61 0 4257
<br /> SARA HOLLAND CONTACT EMAIL..:SARAa©GSHEATING.COM
<br /> AGREEMENT:I hereby certify that l have read and examinee,a dl plication and kr,ow f,c same to be true and orrr . 1'provls,ons of laws and ordinances gave ing this
<br /> type of work will be completed whether specified herein or not. nm,.granting of a permit does not presume to give,author.fy to violate or cancel the provisions of any tither state or
<br /> local law regulating construction or the performance of constr cfFop. That 1 am aufhvri.recf icy the owner of this prover-:y to perform the work for which application is m de and I
<br /> comply with the State Contractors Law 18.27 RCW and.296.200 WAC. Ci of Everett Offieia[Use O i
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<br /> Ovriieli uttiorizedAgen£Signature Date ° (Revised 1/11/2019) Pagel-ApOlication
<br /> £19 O10—.053
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