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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa,gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: C u.,,nn - 1 r>iy- BUILDING AREA: 1042 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ✓❑ADDITION 0 TENANT IMPROVMENT CI REMODEL
<br /> BUILDING USE: ❑✓ +SFR
<br /> /. ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 2168.56 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> NEW SUBPANEL AND FEEDER FOR OUTBUILDING, WITH LIGHTS AND PLUGS
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO ✓❑YES-Select Scope: ❑Service ✓❑Feeder ❑✓ Circuits-#:3 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom 0 Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> ❑ 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 /> ❑Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓/ NO L I YES--See Below&Pg.2
<br /> 7f• 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 I 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: ONO ❑YES-See Below&Pg.3
<br /> ElPursuant 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 /> 1. .. ... .� U ,a ` `R OSISSI:CzON'[�ACT INFO1RWMP;N SI �z t 'i ';L , t
<br /> OWNER NAME: COURTNEY VANDYKE TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2809 LEONARD DR
<br /> EVERETT STATE WA ZIP 98201
<br /> OWNER PHONE:425-530-6406 OWNER EMAIL:CEVANDYKE.DESIG N@GMAI L.COM
<br /> CONTRACTOR NAME: GS HEATING, COOLING&ELECTRICAL LLC
<br /> CONTRACTOR ADDRESS: sTREET3409 EVERETT AVE
<br /> ore EVERETT STATE WAziP 98201
<br /> CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:SARA@GSH EATING.COM
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058
<br /> PRIMARY CONTACT: LIOWNER ©CONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> SARA HOLLAN D CONTACT EMAIL:SARA@GSHEATING.COM
<br /> AGREEMENT.I hereby certify that I have mad and examined this application and know the same 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 I
<br /> comply with the State Contractors Law 16.27 RCW and 296,200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> EI,q 11- 0 \
<br /> Ownee'7Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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