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<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 j FAX 425-257-8857 !(E)everetteps@everettwa.gov! www.everettwa.govipermits
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<br /> PROJECT ADDRESS: 1625 MCDOUGALL AVE BUILDING AREA: 1334 sq ft
<br /> PROJECT TYPE: El NEW CONSTRUCTION ®ADDITION D TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: 0 SFR D TOWNHOUSE D DUPLEX ❑ADU D MULTi-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> .'s EMO ELECTRIGAVA!!PUC.PAT1ON(INFORM/ TION.& .ESC.RIPTION OF,WORK; r. ;, ,if s,f
<br /> CONTRACT PRICE OF WORK:$ '®® ✓ ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 80TO90OFSWAP
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE.WORK? El NO 0 YES-Select Scope:D Service 0 Feeder El Circuits-#:2 D Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO CD YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data D Intercom Q Thermostat El Audio 0 Secure Access D Security System
<br /> El 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 /> D Other(List All):
<br /> i . ,..AI I ti s : CODE( ONPLIANCE
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<br /> a.
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: �
<br /> NO D YES-See Below&Pg.2
<br /> By checking this box,I am stating that i have read and understand all of WAC 296-468-900,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 DYES-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 /> ,c f ;� r , , 4 CONTAC E INFORNIA`tfION�N s r ti.
<br /> r:,.!�a s,;;3� <,.<u, s <: i,;,t,,,,h..,G ;� ,,,,� ,1�«.,..r .r 71Y�;:, ., ass. u! . ,,, 1 �r ,s i�r,.,<x f ,7 �,J t'�°fir.
<br /> OWNER NAME: JAMES BECKER TENANT BUSINESS NAME(If commercial):
<br /> OWNER MAILING ADDRESS: smear 1625 MCDOUGALL AVE
<br /> cry EVERETT sTATE WA zip 98201
<br /> OWNER PHONE:425-258-5754 OWNER EMAIL:
<br /> CONTRACTOR NAME: gs heating
<br /> CONTRACTOR ADDRESS: STREET 3409 everett ave
<br /> CITY everett STATE wa zip 98201
<br /> CONTRACTOR PHONE:425-6104257 CONTRACTOR EMAIL:MELANIE@gsheating.com
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60068
<br /> PRIMARY CONTACT: DOWNER [✓CONTRACTOR ElOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-510-4257
<br /> MELANIE MENDENHALL CONTACT EMAIL:MELANIE@gsheating.com
<br /> AGREEMENT:I hereby certify that;have read and examined this application and know the same to be true and correct All provisions of laws end ordinances governing this
<br /> Type of work will be completed whether specified herein or not. The granting of a permit does not presume to gree authority to violate or cancel the provisions of any other state or
<br /> 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 1
<br /> comply with the State Contractors Law 18.27 RCW and 298 200 WAC. C of Everett Official Use on
<br /> PERMIT#:
<br /> tir -, �. V -i ig . E 12� I�1Z
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/20/9) Page 1-Application
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