9609 BELMONT DR 2020-01-21 - Laserfiche WebLink

'' ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES "�[?L 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 r FAX 425-257.8857 I(E)everetteps@everettwa.gov I www.everettwa.govtpermits PROJECT ADDRESS: 9609 BELMONT DR BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ©ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑✓ SFR 0 TOWNHOUSE 0 DUPLEX 0 ADO 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL CONTRACT PRICE OF WORK:$ 9989.10 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: DUCTLESS HEAT PUMP INSTALLATION THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE"VOLTAGE;WORK? ❑NO ❑YES-Select Scope:0 Service 0 Feeder ✓❑Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? 21 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): Q Data ❑Intercom 0 Thermostat ❑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 All): a atiftW wINZUM;a�,i4 $ ?t`ti. .r, fit` ,DE COMPLIANCE...Rs< t�. .r..,,. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDfOR PERSONAL CARE FACILITIES: IA NO Li YES--See Below&Pg.2 r 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 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:ONO OYES-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 U 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 AFFIDAVITonpage 3 of this application to receive ain�exemption n from this licensing/certification requirement. °, t Mpat a , nett iNOS ` SNAP ; rT 74FORii��iR TION�`Si�' NA M°d"*� 'G,�I�hd„�r�j �<a Y r�.,' , .,y�' u,..a.�� M� .,r.T�. .tw... x..�. ..�.. �_.F,. ....., ., Q'.•a.f..ss�a.'4f t�s}r^ ,rv �f !.�°5,��`'�YC�{°k. ��.,�;56-.�.2xSF.� OWNER NAME: DOYLE BROWN TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREET 9609 BELMONT DR cm, EVERETT STATE WA zp 98208 OWNER PHONE:425-355-5588 OWNER EMAIL:N.BROWN36@FRONTIER.COM CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: sTREET 3409 everett ave cm everett STATE Wa zip 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:ALISHA@gsheating.corn CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):80058 PRIMARY CONTACT: DOWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 ALISHA CLOGSTON CONTACT EMAlL:ALISHA(agsheating.com AGREEMENT:t hereby certify that I have read and examined this application and know the same to be true and correct. Aff provisions of laws and ordinances governing this type of worn wilt 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#: C ALISHA CLOGSTON I" g6/11 E e J I q ((' Owner/Authorized Agent Signature Date (Revised 111112019) Page 1,ApPliGdttpn