408 ROSE WAY 2019-11-07 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 04TerrCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERE I I,WA 98201 (P)425-257-8810 j FAX 425-257-8857 j(E)everettepseeverettwa.gcv 1 www.everettwa.govloermits PROJECT SITE,INFORMATION , PROJECT ADDRESS: 408 ROSE WAY BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION .Zi ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: C✓1 SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL = ELECTRICAI PPLICAflON,JNFOR AXION &ODESC IP 01440E WORK t W , CONTRACT PRICE OF WORK:$ 4602.40----25,0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: AIR HANDLER INSTALLATION /1 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑YES-Select Scope:❑Service El Feeder [ Circuits-#:2 C Complete Re-wire LOW VOLTAGE WORK? Z NO ❑YES-#of Devices: El SELECT SCOPE(REQUIRED): ❑Data Ell intercom ED Thermostat ❑Audio 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): • 'CODE;COMPLIANCE ',n,. , IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ZNO El YES--See Below&Pg.2 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: ZNO DYES-See Below&Pg.3 Pursuant to ROW 19.28.281, 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. ,. E ,t':„ ,i11 :CO111TAc.T aINFORMATION ` , ' s or ;;;yf, h OWNER NAME: MARK WIGGINS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sneer 408 ROSE WAY G,TY EVERERTT STATE WA ZIP 98203 OWNER PHONE:2069546510 OWNER EMAIL;INSTALL@GSHEATING.COM CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: SEE 3409 everett ave crr! everett STATE wa Z.P 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:ALISHA@gsheating.com CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 ALISHA CLOGSTON CONTACT EMAIL:ALISHA@gsheating.com AGREEMENT*I hereby certify that i have read and examined this application and know the same to be true and correct. All provisions flaws and ordinances governing this type of wont 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 t em authorized by the owner cf this property to perform the work for which application is made and i comply with the State Contractors Law 18.27 RCW and 298.200 WAG. City of Everett Official Use Only PERMIT#: ALISHA CLOGSTON qi 9`I 111 E VA o9 ` ( 2 Owner/Authorized Agent Signature Date i (Revised III//20/9) Page 1-Application