Laserfiche WebLink
110 • <br /> 477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8657 I(E)everetteps@aeverettwa.gov I www.everetlwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2301 118th PL SE BUILDING AREA: sq ft <br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: d SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> . ' :ELECTRICAL APPLICATION INFORMATION &•DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 900.00 JASSOCIATED BUILDING PERMIT*(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install circuit and gfci for new AC install <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select Scope:❑ Service ❑Feeder ❑✓ Circuits-#:1 0 Complete Re-wire <br /> LOW VOLTAGE WORK? 0 NO YES-#of Devices:1 <br /> SELECT SCOPE(REQUIRED): 0 Data ❑ Intercom 0 Thermostat 0 Audio ❑ Secure Access ❑ Security System <br /> ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> 17 Other(List All);circuit and gfci <br /> CODE COMPLIANCE • <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑J NO U YES--See Below&Pg.2 <br /> ❑ 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO EYES-See Below&Pg.3 <br /> n Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> gee Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT-INFORMATION• . • <br /> OWNER NAME: Kenneth Perez TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2301 118th P SE <br /> c,Tr Everett STATE WA zip 98208 <br /> OWNER PHONE:(206)818-3848 OWNER EMAIL:NA <br /> CONTRACTOR NAME: Greenwood Heating &AC <br /> CONTRACTOR ADDRESS: STREET825 S Stacy ST <br /> CRY Seattle STATE WA zip 98134 <br /> CONTRACTOR PHONE:(206)784-1818 CONTRACTOR EMAIL:permits@greenwoodheating.com <br /> CONTRACTOR LIC.#(REQUIRED):GREENHA922U7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 043985 <br /> - <br /> PRIMARY CONTACT: DOWNER CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(206)784-1818 <br /> Greenwood Heating &AC CONTACT EMAIL:permits@greenwoodheating.com <br /> AGREEMENT.:!hereby certify that I have read and examined this application and know the same lobe lure and correct All provisions of taws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. Thal!am authorised by the owner of this property to perform the work for which application is made and i <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WA C. City of Everett Official Use Only <br /> PERMIT#:q <br /> 5/15/2019 E ` OB "" vO 2 <br /> Owner/A orized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />