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ELECTRICAL PERMIT APPLICATION
<br /> 477. 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 I www,everettwa.govlpermits
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<br /> PROJECT ADDRESS: 8408 18TH AVE W Uni+ It V : 1009 sq ft
<br /> PROJECT TYPE: ❑NEW CONSTRUCTION ©ADDITION ❑TENANT 1MPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 597.74 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> NEW WASHER CIRCUIT
<br /> •
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE?VOLTAGE;WORK?; ❑NO ❑✓ YES-Select Scope:.. . p El Service ❑Feeder ❑✓ 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 /> ❑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: U NO El YES--See Below&Pg,2
<br /> f
<br /> f By checking this box,,I am stating that I have read and understand all of WAC 296-4613-900,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: CZINO DYES-See Below&Pg.3
<br /> LPursuant 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.
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<br /> OWNER NAME: DAVID MAKOVEC TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 8408 18TH AVE W
<br /> cm. EVERETT STATE WA ZIP 98204
<br /> OWNER PHONE:707-774-2930 OWNER EMAIL: DAVE13500@YAHOO.COM
<br /> CONTRACTOR NAME: gs heating
<br /> CONTRACTOR ADDRESS: sreEET3409 everett ave
<br /> cnv 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: DOWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> MELANIE MENDENAHALL CONTACT EMAIL:MELANIE@gsheating.com
<br /> AGREEMENT.I 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 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 Lew 18.27 RCW and 298.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> ✓ 144rAl w i -oak -( i!>raa2re3 E 2 O ( - oog
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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