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477 . ELECTRICAL PERMIT APPLICATION
<br /> 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 j www,everettwa.gov/permits
<br /> PROJECT SI,TE3INFORMATION - ,
<br /> PROJECT ADDRESS: 2221 RUCKER AVE BUILDING AREA: 1860 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 /> l ELECTRICAL APPLICATION;INFORMATION;'&<,DESC;RIPTION OFWORK, f '
<br /> CONTRACT PRICE OF WORK:$ 2011.54 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> ADDING 2 NEW 240V WALL HEATERS IN TWO BEDROOMS
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO Q YES-Select Scope:❑Service ❑Feeder 0 Circuits-#:1 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> Cl 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):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO U 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 /> Y 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: ✓❑NO DYES-See Below&Pg.3
<br /> FPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> i V I 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: KELSEY BELLI N TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 19827 183RD PL NE
<br /> arY WOODINVILLE STATE WA , 98077
<br /> OWNER PHONE:425-354-8250 OWNER EMAIL:KELSEYBELLIN@GMAIL.COM
<br /> CONTRACTOR NAME: GS HEATING,COOLING&ELECTRICAL LLC
<br /> CONTRACTOR ADDRESS: 5TREsr3409 EVERETT AVE
<br /> Orr 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 certlfy that l 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 I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 1827 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> C yi_ EIP01-0
<br /> Owner/Authorize;.Agent Date (Revised 1/11/2019) Page 1-Application
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