417 49TH ST SW 2022-03-04 - Laserfiche WebLink

• ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwagov/permits OLT PROJECT SITE INFORMATION PROJECT ADDRESS: 417 49TH ST SW BUILDING AREA: 1400 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ' - ELECTRICALAPPLICATIONINFOR MATION & DESCRIPTION OFWORK. , , CONTRACT PRICE OF WORK:$ 3587 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: REPLACE 200AMP PANEL, ADD OUTSIDE LIGHT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) . LINE VOLTAGE WORK? El NO ❑YES-Select Scope: ❑Service ❑ Feeder ✓❑Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat El Audio ❑ Secure Access El 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. El Other(List All): CODE COMPLIANCE ;'. 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. rr� ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: IJNO EYES-See Below&Pg.3 I I 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. CONTACT INFORMATION OWNER NAME: TIPPY MATHISON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 417 49TH ST SW c,n EVERETT STATE WA ZIP 98203 OWNER PHONE:425-770-8737 OWNER EMAIL:TI PPI MATH ISO N@COMCAST.N ET CONTRACTOR NAME: GS HEATING CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE CITY EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60058 PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-4257 MELANIE MENDENHALL CONTACT EMAIL:MELANIE@GSHEATING.COM AGREEMENT 1 hereby certify that 1 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 lam 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#: a,,.//_,.,/ 0'14/1/ E n 2 - O S 2 Owner/A tPorized Agent Signature Date (Revised 1/11/2019) Page 1-Application