10517 4TH AVE W 2019-11-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLI,ATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 J FAX 425-257-8857 J(E)everetteps@everettwa.gov www.everettwa.gov/permits P ROJECT,SITE,I NFORMATION: PROJECT ADDRESS: 10517 4TH DR SE BUILDING AREA: 1355 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑✓ SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL 'ELECTRICAL2APP,,:LIGATION"'I'NFORMATIONa& DESCRIPTI;ON OF'.W,O,RK , CONTRACT PRICE OF WORK:$ 755.42 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 30 AMP 120 V RV RECEPTACLE, 1 OUTDOOR DUPLEX RECEPTACLE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO OYES-Select Scope: El Service El Feeder ❑✓ Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat El Audio El Secure Access El 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. ❑ Other(List All): CODE,fi COMPLIANCE \, IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO LJ YES--See Below&Pg.2 / By checking , I am I have read all of B-9 ,selected the specific reason on page 2 1/ of this applicationthisbox(see nextstating page)that,AND Plan Reviewand is NOTunderstand required WAC because296-46I meet all00of 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: ONO 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. CONTACT;INFORMATION OWNER NAME: JAIME & NIKKI RINGER TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10517 4TH DR SE c„y EVERETT STATE WA zip 98208 OWNER PHONE:425-686-2929 OWNER EMAIL:DIZZYEDGE77@GMAIL.COM CONTRACTOR NAME: GS HEATING, COOLING &ELECTRICAL LLC CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE ern EVERETT STATE WA as 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:SARA@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60058 PRIMARY CONTACT: DOWNER ECONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-4257 SARA HOLLAND CONTACT EMAIL:SARA@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 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 1 comply with the State Contractors Law 18.27 RCW and 296,200 WAC. City of Everett Official Use Only PERMIT#: �� l� E \ tb�_ Owner/Authorize`d Agent Signature Date (Revised 1/11/2019) Page 1-Application