1903 HOLLOW DALE PL B 2021-12-10

• 0 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 32C0 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits 0(f ft_ i '.ROJECT",SiTE.INFORMATION . PROJECT ADDRESS: 1903 — • • A PL UNIT B BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION IZI ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: E SFR ❑TOWNHOUSE 0 DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL A•P.PLICATION.INPORMATION &°DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 3668.300 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: GAS FURNACE REPLACEMENT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT/APPLY) LINE VOLTAGE WORK? ❑NO _J YES-Select Scope: ❑Service ❑Feeder ❑✓ Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: ' SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Au io El Secure Acbess El Security System ❑ Fire Alarm-Installations under this permit only include lectrlcal wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location ana inst'llation approval. ❑Other(List All): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑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 L10ENSURE: ❑✓NO 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. CONTACTINFORMATION OWNER NAME: ELIZABETH MICHELSON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1903 HOLLOWDALE PL c,r. EVERETT STATE WA ZIP 98204 OWNER PHONE:4252394252 OWNER EMAIL:LIZ@MICHELSONLAW.COM CONTRACTOR NAME: gs heating • CONTRACTOR ADDRESS: STREET 3409 everett ave CITY everett STATE 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: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 ALISHA CLOGSTON CONTACT EMAIL:ALISHA@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 1 comply with the State Contractors Law 18,27 RCW and 296.200 WAD. City of Everett Official Use Only PERMIT#: ALISHACLOGSTON Cd2-4119 E n C --� �� 2 J Owner/Authorized Agent Signature Date (Revised 1/11/2019) \ Page 1-Application