5019 RUCKER AVE 2020-04-02 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 477CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425.257-8810 I FAX 425-257-8857 I(E)everetteps(g}everellwa.gov I www.everettwa.govlperm its PROJECT•SITE INFORMATION. • PROJECT ADDRESS: 5019 Rucker Ave Everett WA 98203 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE ❑DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK . CONTRACT PRICE OF WORK:$ ' I ) ASSOCIATED BUILDING PERMIT*(if applicable): DESCRIBE SCOPE OF WORK: New circuit and gfci for mini split install x2 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ✓❑YES-Select Scope:❑Service 0 Feeder 0 Circuits-#:2 0 Complete Re-wire LOW VOLTAGE WORK? El NO 0 YES-#of Devices:2 SELECT SCOPE(REQUIRED): 0 Data 0 Intercom 0 Thermostat ❑Audio ❑Secure Access 0 Security System El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑✓ Other(List All):x2 circuit and gid • • •.I.CODE_;COMPLIANCE:: ;.-.':. : • : . .. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO 0 YES--See Below&Pg.2 1-1 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 I I of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:©NO OYES-See Below&Pg.3 ❑ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. •. 'CONTACT.:INFORMATION ' . • OWNER NAME: Yonas Debela TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5019 Rucker Ave cm Everett STATE WA ap 98203 OWNER PHONE:(425)903-7989 (OWNER EMAIL:NA CONTRACTOR NAME: Greenwood Heeling&AC CONTRACTOR ADDRESS: smsaT825 S Stacy ST cmt Seattle STATE WA 2,P 98136 CONTRACTOR PHONE:(206)784-1818 CONTRACTOR EMAIL:permits@greenwOOdheating.COm CONTRACTOR LIC.#(REQUIRED):GREENHA922U7 1CITY OF EVERETT BUSINESS LIC.#(REQUIRED):043985 PRIMARY CONTACT: DOWNER ZCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(206)784-1818 Greenwood Heating &AC CONTACT EMAIL:permits@greenwoodheating.com AGREEMENT:!hereby certify that t have read and examined this application and know the same to be true and correct, All provisions of laws and ordinances governing this 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 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 end I comply with the State Contractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only PERMIT#: r01.1% 5/14/2019 E oS Owner/A orized Agent Signature Date (Revised 1111/2019) Page 1-ApplIcation