3202 54TH ST SW 2019-11-15 - Laserfiche WebLink

EL :TRICAL PERMIT APPLICMIDN CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa_gov/permits grr <`,. PROJECT SITE SINFORMATION PROJECT ADDRESS: 3202 54TH ST SW BUILDING AREA: 1660 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT © REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION, INFORMATION&,D;ESCRIP;TION OF WORK .:i CONTRACT PRICE OF WORK:$ 2249.81 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD CEILING PLUG & CAN IN KITCHEN, ONE OUTDOOR RECEPTACLE, TWO HALL CANS, AND ONE BATH FAN. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT ityl PLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Fee r ❑✓ Circuits-#:4 ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: / SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Aud ❑Secur Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include ele'n wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑Other(List All): S` t,,E C: DE0OMLIANCE t .. °. : v .;;,,,k.' .�. ...1.. .1 1. ... ..�.. `.. i .� .. �..CP IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑YES—See Below&Pg.2 By ch , I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 V of this applicationecking thisbox(see next page),AND Plan Review is NOT required because I meet all of the fallowing sub sections that do not See Page 2 require Plan Review. OYES ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑✓ O NO YES-See Below&Pg. 3 ✓ wrhsouuat ntthteo pRroOpWer 1e9le2ct8r.i2c6al1,icperonpseinrtyg aonwd nceersrtifiacnadtiloena,soerhoexldeemrsptcannot pcehrfeocmingeletcaboxl w, Ioarkm osntabtunilgditnhgast for arevne tcsoamleploetreled aasned See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. :CONTACT INFORMATION` a, , OWNER NAME: ANDREW NESS TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3202 54TH ST SW c,n EVERETT STATE WA zip 98203 OWNER PHONE:206471-0000 OWNER EMAIL:MISTERANDMISSESNESS@GMAIL.COM CONTRACTOR NAME: GS HEATING, COOLING & ELECTRICAL LLC CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE CITY EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-6104257 CONTRACTOR EMAIL:SARA@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60058 PRIMARY CONTACT: ❑OWN ER ❑✓CONTRACTOR ❑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! comply with the State Contractors Law 18.27 RCWand 296.200 WAC. City of Everett Official Use Only PERMIT#: 1; ? 1r:,, u• t -- .1 P 1,� E c3I,e s 003 Owner/Authorized Agent Signature - Date ' ' (Revised 1/11/2019) Page i-Application