3604 RUCKER AVE 2022-02-16 - Laserfiche WebLink

r • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits 4rerr fa : . ,....:,. PROJECTISITEINFORMATION„, PROJECT ADDRESS: 3606 RUCKER AVE BUILDING AREA: 1116 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: E COMMERCIAL ELECTRICAL APPLICATION t;INF.ORMATION B DESCRIPTI.ON OF:x;WORK , t " CONTRACT PRICE OF WORK:$ 3066.52 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: WALL FURNACE REPLACEMENT ON MOTHER-IN-LAW PROPERTY (3604 RUCKER AVE) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE:VOLTAGEWORK? ❑NO ❑YES-Select Scope: p ID Service [I] Feeder E Circuits-#:2 El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑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'CO:MPLIANCE ;`, x IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑NO CrYES--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 OYES-See Below&Pg.3 u 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. t, ONTACT'>INFORMATION OWNER NAME: RAY GURZYNSKI TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3606 RUCKER AVE cnv EVERETT STATE WA zip 98201 OWNER PHONE:(206)240-5720 OWNER EMAIL: CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: sTREET3409 everett eve CITY everett STATE wa „ 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 ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-4257 MELANIE MENDENHALL CONTACT EMAIL:MELANIE@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#: L ii PO i(- UOIA AC/ilk ° Ia0)-71 °) E 1.0 \2- l"))O Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application