417 49TH ST SW 2022-01-24 - Laserfiche WebLink

• • /A1V-Ij--1 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES Nadgi-I 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwagov/permits P.ROJECT:SITE:INF,ORMATIION PROJECT ADDRESS: 417 49TH ST SW BUILDING AREA: 1500 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION RI ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ✓❑SFR ❑TOWNHOUSE ❑DUPLEX it ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DES.CRIPTIION.OF:WORK CONTRACT PRICE OF WORK:$ 12962.44 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: HP INSTALL THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGEWORK? CI NO Cl YES-Select Scope:0 Service El Feeder ©Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO RI YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom RI Thermostat ❑Audio El 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): C ,MPLI€ANCE"':i IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ©NO 0 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 DYES-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. CONI%ACT:>INFORMATION OWNER NAME: TIPPI MATHISON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREET 417 49TH ST SW c,,,. EVERETT STATE WA zip 98203 OWNER PHONE:425-770-8737 ,OWNER EMAIL:TIPPIMATHISON@COMCAST.NET CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: STREET 3409 everett ave CITY everett srATE wa np 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@gsheating.com CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 PRIMARY CONTACT: DOWNER ZCONTRACTOR DOTHER(PIease Specify) CONTACT NAME: CONTACT PHONE:425-610-4257 MELANIE MENDENHALL CONTACT EMAIL:MEAN IE@gsheating.cam 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 WAC. City of Everett Official Use Only PERM IT AJU.P LA, i e-ja I I I 1 A g E l ' (t0 Ovhier/Authorized Agent Signature Date (Revised 1/i1/2019) Page 1-Application ,-3