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<br /> 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 I www.everettwa.gov/permits
<br /> 0477
<br /> M . :n.kt, 3.Y i `S4 .,.,R;.:yes+.. . RPROJ ECT SFrE#NFORMATION y ._..,. RSEg:Voggisi m
<br /> PROJECT ADDRESS: 402 ROCKEFELLER AVE BUILDING AREA: 2480 sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ADDITION ❑TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: IZI SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> .* :<` �,_' �.'.'�',. ..` ;,ELECITRICM tAPPL1,CATION]NupRM11TioN.8.DESCRIPTIcmOFWWORKei.+,;
<br /> CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(If applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> AIR HANDLER INSTALL
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINEVOLTAGEWORK?. ❑NO ❑YES-Select Scope: ❑Service ❑Feeder ©Circuits-#:2 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO Z YES-#of Devices:1
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ✓❑Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> El 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):
<br /> v it , 11E N s � £ s +s� s�PPRE> „ ,,tis. l .., , r L$t''1'.',s.a.;.I.'., , ..:�'{Yell nI<r��,r.., ,,. yt�S,.hi,7 Es.o. r ,x:,.,.yi,t.�; . �.,,�� �,��� .,�....,. ,�: .g�,l,,{ �.,t.r-�.s�<,v , �,.,,�h���r}.� .. �COIIAPLIANCE. ,,�++•.,,
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LI NO ❑YES--See Below&Pg.2
<br /> fl 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 /> 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 EYES-See Below&Pg.3
<br /> — Pursuant 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.
<br /> 3 f 4 I,, ,,' f�, „f z`,''CONTAGT;,INFORMATION N'� ,, : y fi t
<br /> . - . , .�:,<..z„ . . ;.., ,Ft..:.. ,�� t .,�.,.. . . .,. ,. .� r��,,,., ,.. ..6�,a��i*i.,,,:z. ..�< ,. �i�r3�Yui�)4r��;,, i, +.a;,.
<br /> OWNER NAME: ANN SBRIZZI TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 402 ROCKEFELLER AVE
<br /> ,,,,. EVERETT STATE WA zip 98201
<br /> OWNER PHONE:425-220-2080 OWNER.EMAIL:annsbrizzi U@liVe.com
<br /> CONTRACTOR NAME: gs heating
<br /> CONTRACTOR ADDRESS: STREET 3409 everett ave
<br /> omr everett STATE wa z,a 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 LICONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> MELANIE MENDENHALL CONTACT EMAIL:MELANIE@gsheating.com
<br /> AGREEMENT:1 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 Law 18.27 ROW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> �� � ice, ( I -a-3/-a-o-a-r) E 20 D( v 1-6-1
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) ' Page 1-Application
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