|
ELECTRICAL PERMIT APPLICATION
<br /> 4477CITY 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
<br /> ➢ r d ?I p }i I; �` 'SSV d q, S I Irfl tfxa,itt'�f % ,. S r� i t Cv}�Q`>ti' s,�� . ,., . . i�, fM ay;i�IE
<br /> �,,,,z,.11�x�/ ��+ .:�h��.,���,�, v���! �,� ;.���� f>� a�,�����>n�PRO,J�C��' ITE�INFO:R:IWrA�T10,N�' � � �� ���F, �;.;i•� ;t t�s�
<br /> .r d F _h... ;1..:.:.....:..,}ii����`..-�� „�'<'�n�,'n�.�l 's8zt �.X14,�?:.•��'•'��iY.�-�h �`,�k`�, '�t:_��,n
<br /> PROJECT ADDRESS: 2215 GRAND AVE BUILDING AREA: -14 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: ©SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> � ;����,t,�� �"�4;r� r� L .,� '� L1C"� ��t?�I iWF�RMATI'O �� °;,�,,, j,,.�.
<br /> ;x� ..,.. z..,... ' >:........ .,...:,t..t:,,..... .... � .�e:.�... .,......;,..�T».,,..:,.....�..,..,..,...��:............:........�...,...�...:;�','�`��[Ji;E�SC7rPmT:�:�;1,�.��..'.<F��EWORKr;�f�i� �c���rls,�sf;�r��,'��t,9r,��r.!
<br /> CONTRACT PRICE OF WORK:$pKits *9-01);/' ' ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACEMENT OF AiR HANDLER
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE;VOLTAGE;';WORK? ❑NO ❑YES-Select Scope:❑Service ❑Feeder ©Circuits-#:1 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices:1
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑intercom El 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):
<br /> ':3i r'�,�(:^,.-aev.}Y ':: „fry .. .„ ..:.,di,v�;�:.,iv :.,;V w ,� .l'fk -
<br /> t'Gfi'
<br /> . 1. -..i•.. '��?F,iF, }. . - U,. ,«`;h,' i. -v^S";r,. -;`"•�' - t '�*; _ ,.rr�R" i. �r:�' -r...,.��z:x.��y �xPW;S•-,, hR ,
<br /> „u.',. �;,,. .n _` � ' 1 ., M ,fr.-a Z.r a. ig'z'i ::a.r :..,'9t:'^t1: ..3..2,,.r :� r. s.:V„ «„�Y3W�". :a•_� ,.a'7n'te
<br /> �r�.�����,.� -.�Y}��x��;� �,�r�r�rM�`���:����;�`S ,Vr����,^'�.�;'�yV���D�,�r'?,`OM,PjE�I�NC;Eve'g,:'�,� ?,�;'r,�'I•`�.:��c�;i=;�W) ; �;� �'�,:n�l�,�itn:�Rart�'�i�r���`��� �r�k�) >;�
<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 296-46B-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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO OYES-See Below&Pg.3
<br /> fl 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 /> pagsrow w,,ammier A
<br /> N IPAP; TgGTAINFORMATPNi MOP;MBEI EMINOM EN
<br /> OWNER NAME: CHRISTIAN&JEANNE BUCHLEJ TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 2215 GRAND AVE
<br /> cm. EVERETT STATE WA ZIP 98201
<br /> OWNER PHONE:425-583-4877 OWNER EMAiL:CHRISTiANBUCHLER@YAHOO.COM
<br /> CONTRACTOR NAME: gs heating
<br /> CONTRACTOR ADDRESS: sTREET3409 everett ave
<br /> crry everett STATE wa ZIP 98201
<br /> CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING.COM
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058
<br /> PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> MELANIE MENDENHALL CONTACT EMAiL:MELANIE@GSREATiNG.COM
<br /> AGREEMENT:t 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/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 /> .1°illIIq E V1 I b- 151
<br /> Ownerl444VaAIL
<br /> zed Agent Signature Date (Revised 1/11/2019) Page 1-Application
<br />
|