1820 100TH PL SE 2022-04-29 - Laserfiche WebLink

E` CTRICAL PERMIT APPLICIPTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 820 100th PI SE BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1,000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replacing electric furnace with new heat pump and fan coil. Adding outside air and installing new stat THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? _ El NO ❑✓ YES-Select Scope: ❑✓ Service El Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices: 1 SELECT SCOPE(REQUIRED): El Data El 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 COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO El 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: ❑✓ 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. CONTACT INFORMATION OWNER NAME: SILVER LK DENTAL BLDG LLC TENANT BUSINESS NAME(If Commercial): PUGET SOUND HEARING OWNER MAILING ADDRESS: STREET 1820 100TH PL SE CITY EVERETT STATE WA ZIP 98208 OWNER PHONE:206-999-7056 OWNER EMAIL:MICHAEL_MEIERS@HOTMAIL.COM CONTRACTOR NAME: GS HEATING &COOLING LLC CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE cm( EVERETT STATE WA ZIP 98208 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:JONATHAN@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19685 PRIMARY CONTACT: DOWNER IiICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-309-6507 JONATHAN D. FARRELL CONTACT EMAIL:JONATHAN@GSHEATING.COM AGREEMENT I 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 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 PEERRMIIT#: 9.&frta.zytafrpp. p—a44.2.11 7-25-19 ` l01 Dfl - \CQ� Owner/Authorized Agent Signature Date (Revised 1/11/2019) ll Page 1-Application