7430 17TH AVE SE 2020-08-28 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 i4terr (P)425-257 8810 I FAX 425 257-8857 (E}event eps[aeveretlwa.gov ' w.everetriva,gov/permits PROJECT,SITEIINFORMATION PROJECT ADDRESS: 7430 17TH AVE SE BUILDING AREA:J w 30 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ';-'ELECTRICAL,APPLICATION_:°INFORMATION,;&'.DESCRIPTION:OF WORK CONTRACT PRICE OF WORK:$ 1000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: REPLACE & REPAIR METER BASE AND SERVICE WIRE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE; (SELECT ALL THAT APPLY) • LINE VOLTAGE WORK? ❑NO 10 YES-Select Scope:©Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑ 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: D NO n YES--See Below&Pg.2 J By checking this box,I am stating that have read and unall W4B0,selected the specific reason on page 2 of this application(see next page),AlND Plan Review is NOTderstand requiredof becauseAC296-I meet 6 -90ail of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO OYES-See Below&Pg.3 ✓ PursROW 8 , perform eior nsale,or lease withoutuant theto proper elect19.2ri.261cal licenprosingrty andowners certificationandleaseholders,or exemption,cannot. By pechecking elthisctrcal box,I amworkon statingbuildings that fI have ret,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: SUE MCDONALD TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: smREET 7430 17TH AVE SE crry EVERETT STATE WA za 98203 OWNER PHONE:425-905-9050 OWNER EMAIL:MCDONALDSUE@JUNO.COM CONTRACTOR NAME: GS HEATING, COOLING& ELECTRICAL LLC CONTRACTOR ADDRESS: STREET3409 EVERETT AVE CITY EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:SARA@GSH EATI NG.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#{REQUIRED):60058 PRIMARY CONTACT: DOWNER E✓lCONTRA CTO R ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-6104257 SARA HOLLAND CONTACT EMAIL:SARA@GSHEATING.COM AGREEMENT:(hereby certify that t have read and examined this application and know the same to be true and correct. Au 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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 V✓AC. City of Everett Official Use Only PERMIT#: ,dQ,t, z i0'1,11 13-II,- E101\2'Dui�b Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application