9630 SHARON DR 2019-11-07 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES CEDAR STREET,EVERETT,WA 98201 (P)425-257-8890 I FAX 425-257-8857 1(E)everetteps(@everefwa,gov I www.everettwagov/permits � x ...>� l < -.v�.$z 4...u°.<�'c .p<:.�'ST? is:` .;,:s ' .. =>f 3 eRaliE !PTS TEIN +ORMAN1 RROe j4MY..Xti 3 w.:,`O }5:,zz ..A PROJECT ADDRESS: 9630 SHARON DR BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION d ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: O SFR ❑TOWNHOUSE ❑DUPLEX 0 ADU MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL mg' ,,.,<;r; r ;;,:„£I£C7` pkwAPP ITA-40N 1NFORmwr1pDIm;gE!scRIP,TTVN F,WOR ENUMs ? . CONTRACT PRICE OF WORK:$ p5(14 IP 0 1° ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: GAS FURNACE REPLACEMENT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE:WORK? Q NO ❑YES-Select Scope:❑Service ©Feeder 0 Circuits-:1 0 Complete Re-wire LOW VOLTAGE WORK? Q NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data ❑Intercom 0 Thermostat 0 Audio 0 Secure Access 0 Security System 0 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. 0 Other(List Ali): ■ EA /►fir .O,.-.<.` ,. -;�;.. 'lf��'Fn:h< . y i fi A,.r A::L , ,vxhr�'n <k:*�v"vy c. ,'.DE:PMAPLIANCE.. t`✓,gr r'3,..<.:,,A UMA34'.<s sEW ' A :f IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [2]NO 0 YES–See Below&Pg.2 • —1 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 I 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:[a INO OYES-See Below&Pg.3 1 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 gee Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. FOR ,,. .Nri .n. 2 ...7.F. .4I. _13 ENOMMe OWNER NAME: AMANDA GIOULIS TENANT BUSINESS NAME(If Commercial): OWNER MAILING;ADDRESS: STREET 9630 SHARON DR crry EVERETT smrs WA an 98204 OWNER PHONE:4257726944 OWNER EMAIL:INSTALL@GSHEATING,COM CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: STREET 3409 evrett ave CITY everett STATE wa zip 98201 CONTRACTOR PHONE:426-252.4402 CONTRACTOR EMAIL:AL.ISHA@gsheating.Com CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 PRIMARY CONTACT: DOWNER [ZICONTRACTOR ®OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 ALISHA CLOGSTON CONTACT EMAIL ALISHA©gsheating.com AGREEMENT;t hereby certify that t have read and examined s application and know the same to be true and correct. All provisions of laws 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 298.200 WAC. City of Everett Official Use Only � PERMIT#: � ALISHA CLOGSTON x�.r11 #q� E Y ctO G6- 9A Owner/Authorized Agent Signature ' nnDate (Revised VI 1/2019) Page 1-Application