1623 MAPLE ST 2021-11-15 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION �, /� CITY OF EVERT I I PERMIT SERVICES #.11!A' .t 3200 CEDAR STREET.EVERETT WA 98201 (P)425-257-5810 FAX 425-257-8857 I(E)everetteps everettwa.gcv i wwv.evarettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1623 MAPLE ST BUILDING AREA: sq ft PROJECT TYPE: _1 NEW CONSTRUCTION ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: C SFR U TOWNHOUSE ❑ DUPLEX U ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORNIATIO VA DESCRIPTION OF,.WORK . CONTRACT PRICE OF WORK:$ 3587.91 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: INSTALLATION OF A GAS WALL HEATER THIS INSTALLATION INCLUDES THE FOLLOWINGr-- SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO NO YES-Select Scope:0 Service t ,Feeder Q Circuits -1 ❑Complete Re-wire LOW VOLTAGE WORK? ri NO ❑YES-#of Devices: 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: 71 NO U 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: 21NO 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 ,,GONTACTJINF ORM AT ION OWNER NAME: HELEN SCHULTZ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: S-RE=- 1623 MAPLE ST �,- EVERETT STATE WA z 98203 OWNER PHONE:4253414689 ,OWNER EMAIL:INSTALL@GSHEATING.COM CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: s'N:.;=r 3409 everett ave Cr everett s-ATE. wa zip 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:ALISHA©gsheating.com CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60058 PRIMARY CONTACT: DOWNER ✓[CONTRACTOR 'OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 ALISHA CLOGSTON CONTACT EMAIL:ALISHA@gsheating.com AGREEMENT:t hereby certify that/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/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 ROW and 296.200 WAC_ City of Everett Official use Only PERMIT#: ALISHA CLOGSTON E I DI 14.1 Owner/Authorized Agent Signature Daze (Revised 1/11/2019) Page 1-Application