2022 VIRGINIA AVE 2023-05-23 - Laserfiche WebLink

• 0 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.everettwa.gov/permits OLT PROJECT SITE INFORMATION PROJECT ADDRESS: 2022 VI RG I NA AVE BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ❑TENANT IMPROVMENT El REMODEL , BUILDING USE: ❑✓ SFR ❑TOWNHOUS ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL :LICATION•`INFORMATION.B;'DESCRIPTION OF WORK ;: CONTRACT PRICE OF WORK:$,as.45 \ c-)QO ASSOCIATED BUILDING PERMIT#(If applicable): DESCRIBE SCOPE OF WORK: STAT WIRE - GAS FURNACE INSTALLATION THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPL LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope:❑Service ❑Feeder Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO YES-#of Devices:1 SELECT SCOPE(REQUIRED); ❑ Data ❑ Intercom ✓❑Thermostat ❑Audio 1 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: 0 NO ❑YES—See Below&Pg.2 — By checking this box, I am stating that I have read and understand al: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 1 meet all of the following sub sections that do not See Page 2 require Pan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO OYES-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: ALICIA ADAMSON TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREFr 2022 EVERETT AVE cm. EVERETT STA~E WA zip 98201 OWNER PHONE:425-330-6527 OWNER EMAIL:ALICIA.ADAMSON@COMCAST.NET CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: STREET 3409 everett ave CITY everett STATE wa ZIP 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:dawn@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 ALISHA CLOGSTON CONTACT EMAIL:ALISHA@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#: ALISHACLOGSTON )a)tb) IG1 E \.Sl 0- \<.O Owner/Authorized Agent Signature bate I ` (Revised 1/11/2019) Page 1-Application