3328 RUCKER AVE 2020-01-30 - 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 I www.everettwa.govtpermits PROJECT ADDRESS: 3328 RUCKER AVE BUILDING AREA: 1634 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ✓❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: O SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL il:i::klaniggeneRMELEPTRIPAILARPILACATIONIINFORMATIOW8aDESCRIpTION.m.Elivmmommagnag CONTRACT PRICE OF WORK:$ 4990.15 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: HEAT PUMP AND AIR HANDLER INSTALL THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE.WORK? ❑NO 0 YES-Select Scope:❑Service ❑Feeder ©Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑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): ..„ ..... ...:........:....:.... .r...... .. .s. :. :......../........: .: ....,...... �rt'.r. ..... ....A!.,1., f.:t::-,...... ,j�:::i::'!:':l+:li.\::.�::..1,_'').:::.:..i;.�'v �.. 1. ,, . v,..s �'i.. n+. ..:'rr_... ... ..... .:�. 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: ENO EYES-See Below&Pg.3 C Pursuant to ROW 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. . , .. .., ..✓, .t ..:.... . ... . .....:. r .... .. .. ..... ...... e>s';` star, s:;f::; OWNER NAME: PAUL DELZELL TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3328 RUCKER AVE cm' EVERETT STATE WA ZIP 98201 OWNER PHONE:360-200-2522 OWNER EMAIL:PAULDELZELLJR@GMAIL.COM CONTRACTOR NAME: GS HEATING CONTRACTOR ADDRESS: sTREET 3409 EVERETT AVE cay EVERETT STATE WA , 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING,COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 PRIMARY CONTACT: DOWNER ❑✓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 WAC. City of Everett Official Use Only PERMIT#: Jv1A.1 ;c t;A.,.,e/tt.4'e,P ( °/ E l67 2 ,OSS Owner/Authorized Agent Signature Date (Revised 1/11/2019) Pagel-Application