129 112TH ST SE 2020-01-23 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT.WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov 1 www.everettwa.gov/permits OrErr :PROJECT SITE^INFORMATION PROJECT ADDRESS: 129 112TH ST SE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ," .ELECTRICAL APPk ATION"INFORMATION:&DESCRIPTION,OF_WORK i" " „ , , CONTRACT PRICE OF WORK:$ 1158`3.33 600 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORM( NEED DISCONNECT, SERVICE OUTLET, NEW ELECTRICAL TO ELECTRIC FURNACE. 6 A T , -e _z� THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT AP;. Y) / LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: E Service ❑ Feede I9 Circuits-#:2 / ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO VS-#of Devices: f / SELECT SCOPE(REQUIRED)- E Data / ( ) ❑Intercom Thermostat ❑Audio' ❑❑ySe6iire Access ❑Security System ❑Fire Alarm-Installations nder 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::COMPLIANCE.:., IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ 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 PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓❑NO 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. , ";CONTACTANFORMATION .. OWNER NAME: RICHARD WAMPLER TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREET 129 112TH ST SE c,r, EVERETT STATE WA z:p 98208 OWNER PHONE:425-345-8920 OWNER EMAIL:KACERREX@HOTMAIL.COM CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: STREET 3409 everett ave crry everett STATE wa zip 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60058 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-4257 MELANIE MENDENHALL CONTACT EMAIL:MELANIE@GSHEATING.COM AGREEMENT:I hereby certify that!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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Only PERMIT#: ` MELANIE MENDENHALL E \ C 0 - O� 3 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application