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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermlts
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<br /> PROJECT ADDRESS: 1405 OAKES AVE BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ✓❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: D SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU Cl MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> tELECTRICAL,APPLICATIONS„I,NFORMATIONi& DESCRIPTION;OF_WORiCiTt t, , i u
<br /> CONTRACT PRICE OF WORK:$ 6479.08 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> STAT WIRE
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APP
<br /> LINE VOLTAGE,,WORK? ❑NO ❑YES;;-Select Scope:❑ Service ❑ Feede.rk Circuits-#:1 ❑:Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑NO ❑✓ YES.-#ofDevices:1 y� 7
<br /> SELECT SCOPE REQUIRED ❑
<br /> ( ) Data ❑'Inte'rcom, ❑Thermostat ❑Aud. ❑6SecGreAccess ❑ Security Systeme
<br /> ❑Fire Alarm-Installations under this permit only Include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> ❑Other(List All):
<br /> . ,. CODE!COMPLIANCE' ,
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑YES—See Below&Pg.2
<br /> U 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 /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review. II �—
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: I���ii INO DYES-See Below&Pg.3
<br /> Pursuant to ROW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> without the proper electrical licensing and certification, or exemption. By checking this box,I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> %CONTACT,;INF,ORMATIO'N,
<br /> OWNER NAME: DAVE BREWER TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1405 OAKES AVE
<br /> EVERETT STATE WA zip 98201
<br /> OWNER PHONE:206-390-4810 OWNER:EMAIL:;DAVIBREW@COMCAST.NET
<br /> CONTRACTOR NAME: gs heating
<br /> CONTRACTOR ADDRESS: sTREEr3409 everett ave
<br /> everett STATE wa z,p 98201
<br /> CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:ALISHA@gsheating.com
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058
<br /> PRIMARY CONTACT: EOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-252-4402
<br /> ALISHA CLOGSTON CONTACT EMAIL:ALISHA@gsheating.com
<br /> AGREEMENT:i hereby certify that!have read end examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> 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
<br /> 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
<br /> comply with the State Contractors Law 18.27 RCWand 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> ALISHA CLOGSTON E
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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