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ELECTRICAL PERMIT APPLICATION
<br /> 477CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov( ww v.everetiwa.gov/permits
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<br /> PROJECT ADDRESS: 6803 BERKSHIRE DR BUILDING AREA: 1542 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ✓❑ADDITION El TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑✓ SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 9980.07 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> INSTALLATION OF HEAT PUMP AND TWO INDOOR UNITS
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE:iVOLTAGE;V ORK?: El NO ❑YES-Select Scope: El Service El Feeder Q Circuits-#:2 ❑Complete Re-wire
<br /> LOW.VOLTAGE WORK? El NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data El Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> El Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO U YES—See Below&Pg.2
<br /> 7 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
<br /> of this application(see next page),AND Plan Review is NOT required because 1 meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓❑NO DYES-See Below&Pg.3
<br /> HPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
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<br /> OWNER NAME: RICH & DAWN RAPP TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 6803 BERKSHIRE RD
<br /> c,Tv EVERETT STATE WA Zip 98203
<br /> OWNER PHONE:425-308-9117 ,OWNER EMAIL:RICHARDRAPP@COMCAST.NET
<br /> CONTRACTOR NAME: GS HEATING
<br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE
<br /> crrr EVERETT STATE WA zip 98201
<br /> CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING.COM
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058
<br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> MELANIE MENDENHALL CONTACT EMAIL:MELANIE@GSHEATING.COM
<br /> AGREEMENT I hereby certify that!have read and examined this application and know the serve to be true and correct. All provisions of laws and ordinances governing this
<br /> 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
<br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 •
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#: ( l
<br /> MELANIE MENDENHALL 10/23/19 E �� \ v r� \ 6
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application •
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