10013 4TH AVE W 2021-02-23 - Laserfiche WebLink

EL CTRICAL PERMIT APPLICTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10013 4TH AVE W BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONST'-CZI,ON ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR V •WNHO' E El DUPLEX ❑ADU ElMULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELE•RICAL APPLICATION INFORMATION 8 DESCRIPTION OF WORK CONTRACT PRICE OF WOl:$ 1,800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF I RK: Disconnect/reconnec ,,sower o urnace, AC unit and replacing stat THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: LI Service ❑ Feeder ✓❑ Circuits-#:2 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ✓❑ Thermostat ❑Audio ❑ Secure Access ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO El YES--See Below&Pg. 2 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 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 YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-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: GILBERT LONNIE & JEANNIN TENANT BUSINESS NAME(If Commercial):THE DIET CENTER OWNER MAILING ADDRESS: STREET 11222 ROOSEVELT WAY NE, #10 CITY SEATTLE STATE WA ZIP 98125 OWNER PHONE:(206) 775-6725 OWNER EMAIL:hairlonster@netzero.net CONTRACTOR NAME: GS Heating & Cooling LLC CONTRACTOR ADDRESS: STREET3409 Everett Ave CITY Everett STATE Wa ZIP 98201 CONTRACTOR PHONE:425-309-6507 CONTRACTOR EMAIL:JOrlathan@gSheatlrlg.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC821QR CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19685 PRIMARY CONTACT: ❑OWNER QCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4.25_309_6507 Jonathan Farrell CONTACT EMAIL:Jonathan©gsheating.com 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 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 WAC. City of Everett Official Use Only PERMIT#: zz a Z2 f 8-25-20 E ?iz9 -cog wner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application