|
ELECTRICAL PERMIT APPLICATION
<br /> 4:77- CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.govlpermits
<br /> n;^>u,`i"n:::�:,,.:,,!rv,,r,�'^'+s,a.i"'{:`iFF,y.,;,.,,�:.:::::._,,..::v.;-:::.:,,>:,;<;�:,`Itr
<br /> f 1.. d
<br /> ,,....,�,,,,.,,�,. ,..t,t.t.�h,.:.,,_.. ,,.. t..,,,..r.:„�t.:r.t:.,::. E T� T.E.1 i ......: . ,;.;•'
<br /> s ,. ... .. ..,. . . :.. M TION....... :...:.:..:...:.:.:. .::.g _;,;;; N
<br /> PROJECT ADDRESS: 5409 SOUND AVE BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ©ADDITION ❑TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: D SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> f;?::i sri,>`r:'rj'4$d,•yi{C.ioy.,�l„°:%il)�d(',`'',. $f ..% }ii•;':� !' .'f' Y ''st: t A �:t!r
<br /> :.:,:.r„r,>.,,.:,,:5,,,.,tr,..,.1{ r,;h,,::<,.tE.1ECTROCAL�:AP..rP.:t4ICA`TIONt; N ; t. :;.y:,:: -�<:_ ,..,,1,;;�n�,:,k',:;:;:,;«<t
<br /> ..�., 4...:..... . . .....e......:.........,... ,,.::...::..,..:. .,. .., ..�,.,. ....,:_�...FO:R:MATZO:N».&'DESCRIPT,IO;N,:.OF,:;:W
<br /> CONTRACT PRICE OF WORK:$ 26,327.00 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> PANEL CHANGE - NEED INSPECTION SCHEDULED FOR FRIDAY 12/13/19 AT 2PM
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOL'TAGE:.WORK? ❑NO Cl YES-Select Scope: ✓❑Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data El intercom ❑Thermostat ❑Audio ❑Secure Access El 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):
<br /> ,.....,.:,,.....,1.t1:.,•t.i. .,i..G,...,1 J...,I,. ..i. ..,:,).`:.U,:'.4'%,�,,;•:n':.y:..,:.,�...,,.,,r,:
<br /> ... ... .......ui.. ,.. ., .,..!.t....:. ., i:. is:,,t.... . .....f .. .,..:.. f::..:; .a
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑NO El YES--See Below&Pg.2
<br /> ❑ 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 OYES-See Below&Pg.3
<br /> — Pursuant 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.
<br /> 1'i!::i"!„y(%'i,�,:tt„'rfi,:;' •'r::.r.i'.I:..:,,,':'.74'i:):.!:..r.::::::�:: y.t. •i!iv:
<br /> :I$ .rv. ..:.r�}�i/U.1:.:1i t.1 :'A:..<:,...tr.t,).,...(,.lP%:,:.....i..!`.S:(.,...1...,r,./::::.. .iilst'
<br /> t............. ... .n.J.,. ..,. ,....... f.... 1... :.,.....t{.::.r.,,el,. .�.,.A..:: :u5`: ,.:i�'l;i:,�.:
<br /> 1 .,.. r..t .... �!v k .. ..,..... ., ., ....e � .. .' .9k .:rf%:! _r%1:'` d:)y ,...{ t.,.RnYt
<br /> ,.., ...r .,..... . }. .. ......:........ .. . t ... ,,. .. ...!., .CONTA'CT, INFO M TI .......:.,.,,.:;...,.,, <.,.,. ,.l. ,.ii.,:
<br /> ,, ,,A, : ,..s. ,Y.... ., ,...f., i,t t... : :.� :t .,. ,..,,....,.. t ,. R A ,. ON�. .., „>t;;; ,,>. i ..t.,.t,. >.,�, ,.;,: :�.;
<br /> .. ........c.........l,..,i.f...................t...,..<.........,....,.,.,v,,.l.......�.s„t.).,,,.>..s..... ,,..:,. ., :.:.:.......... ./.. .:. .. .. .. .,...,....�1:'",,,, •$S;'i ,.,s�%tat-, r;,t:�t.{s t:�.,s,li` r;'r.5.,.,1':
<br /> OWNER NAME: JEFFREY MAYNARD TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 5409 SOUND AVE
<br /> City EVERETT STATE WA ZIP 98203
<br /> OWNER PHONE:4259238017 OWNER EMAIL:TWARON@HOTMAIL.COM
<br /> CONTRACTOR NAME: gs heating
<br /> CONTRACTOR ADDRESS: STREET 3409 everett ave
<br /> CITY everett STATE wa ZIP 98201
<br /> CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:ALISHA@gsheating.com
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058
<br /> PRIMARY CONTACT: DOWNER OCONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-252-4402
<br /> ALISHA CLOGSTON CONTACT EMAIL:ALISHA@gsheating.com
<br /> 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
<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 Jew 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 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> ALISHA CLOGSTON E 101
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
<br />
|