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ELECTRICAL PERMIT APPLICATION -
<br /> 0477. 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: 6408 COMMERCIAL AVE BUILDING AREA: 2162 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT O REMODEL
<br /> BUILDING USE: LTJ SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNiTS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 2191.61 ASSOCIATED BUILDING PERMIT#(if applicable);
<br /> DESCRIBE SCOPE OF WORK:
<br /> ADD NEW RECEPTACLE IN GARAGE, AND BASEMENT
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO ©YES-Select Scope:❑Service El Feeder ❑✓ Circuits-#:2 El Complete Re-wire
<br /> LOW VOLTAGE WORK? NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio El Secure Access
<br /> 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 /> • El Other(List All):
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<br /> IS THiS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑NO ❑YES—See Below&Pg.2
<br /> By checking this box, I am stating that I have read and understand all of WAC 296.46E-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. r,�
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:C✓�NO DYES-See Below&Pg.3
<br /> 1-71 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.
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<br /> OWNER NAME: HANNAH PITTMAN TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: Sraeai 6408 COMMERCIAL AVE SE
<br /> cm„ EVERETT STATE WA zip 98203
<br /> OWNER PHONE:425-232-7650 OWNER EMAiL:RETROPHILE04@GMAIL.COM
<br /> CONTRACTOR NAME: GS HEATING, COOLING&ELECTRICAL LLC
<br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE
<br /> CITY EVERETT STATE WA ZIP 98201
<br /> CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:SARA@GSHEATING.COM
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60058
<br /> PRIMARY CONTACT: DOWNER ©CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> SARA HOLLAND CONTACT EMAIL:SARA@GSHEATING.COM
<br /> AGREEMENT:I 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 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 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> E ��. Z ..--05
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<br /> Owner/Authorize'd eh Signature Elate (Revised 1/11/2019) Page 1-Application
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