2611 CLEVELAND AVE 2020-01-22 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION �� CITY OF EVERETT PERMIT SERVICES ^'d a 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 J(E)everetteps@everettwa.gov I www.everettwa.gov/permits PRO.JECT;SITE INFORMATION PROJECT ADDRESS: c \ r'; , v 4 BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑REMODEL BUILDING USE: ©SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL EL'EGTRICAL AP,PLICATION;INFORMATI'ON.�'';DESCRIP.,T:ION O ;WORK CONTRACT PRICE OF WORK:$ C\; `, ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: •, ,' ,n i G n • \ ''f ' % t``� Z 7` 1�.�✓ '!� • i THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY),"" LINE VOLTAGE WORK?; ❑NO [ ES-SeleCt Scope;,❑ Lf service ❑ Feeder Circuits#. ❑Complete Re-wire LOW.VOLTAGE WORK?> NO ❑YES-#of Devices: SELECT SCOPE.:(REQUIR D): ❑ Data ❑ Intercom ❑Thermostat El El❑Secure Access ❑Security;System El 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): THIS PERMIT EDUCATION,INSTITUTIONAL, IS TUTIONAL,HEALTHCNDDQ POMONALACnAREEFACILITIES: LI NO YES--See Below&Pg.2 — 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 — 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 PERFORM( G WORK AS THE CONTRACTOR WITHOUT ELECTRICAL L10ENSURE: ONO EYES-See Below&Pg.3 Pursuant to RCW 19.2 .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. - GONTACT�INF:ORMATION, _� ' OWNER;NAME: '+f c •ei.;, 'TAP „tri v TENANT BUSINESS NAME(If Commercial): OWNERMAILING ADDRESS: STREETeD i1t T 5,;i;P is/ t; tai cITYt 7\.. 4(.l - C 44c `!1-'?iC t STATE ZIP OWNER PHONE: ',JCL:. - lv : `•kki- OWNER EMAIL: CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: STREET3409 everett ave cry everett STATE wa zip 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:dawn@gsheating.com CONTRACTOR LIC.#(REQUIRED):OSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60056 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 dawn wei mer CONTACT EMAIL:dawn@gsheating.com AGREEMENT:1 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 specfied 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 perfd(mance of construction. That lam authorized by the owner of this property to perform the work for which applicaton is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: E 1x1 c dawn w "� � 1 °"� uL< b� Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-App(cation