7702 BEVERLY BLVD 2019-06-19 - 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 (E)everetteps@everettwa.gov I www.everettwa.gov/permits gigillageMISMSEANGSiFiMMROJECIESIMIMPRMATIONISOMMISMINCEM:: PROJECT ADDRESS: —.710c-}— '6:we BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: El SFR 0 TOWNHOUSE EI DUPLEX CI ADU U MULTI-FAMILY-#OF UNITS: CI COMMERCIAL KNOMMIROMEWTRIPAIVARIWCATIONMAORMATIONWPESPRIATIONMORKSMINNW CONTRACT PRICE OF WORK:$ 0;0 ASSOCIATED BUILDING PERMIT#(if applicable): - DESCRIBE SCOPE OF WORK: 9,4_, c \NOM --c-f,A-vvig . , vazi{ • • THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) tiNENP4TAgEtWORK? NO 2rYES',,SelectScope:,Ef:$eroce CI,Egeder D'Completefte-wire LOWNOLTAGE WORK? [71 No SELECT:$PQREI(REQUIRED): ED9ta CI IntercOM 0 Thermostat El'Audio 0 BectireACCess ElSecurity System 0 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. CI Other(List All): MatitaatISSIBIENEMONEMPAIMAMPREMOTARIONORgiNfilaglitEMEMBICAS IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: lid NO U YES—See Below&Pg.2 n 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: IZINO 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 IMENSIRENNOMISSORMIONINEVAONTAARIN,EORMATIMOSSESSMORMENNENONMENEM OVVNER.NAME: \N DAr Nvnt-Y1 ;41 A 'ENANT BUSINESS NAME(If Commercial): k•Atrisrl'AA-C,e OWNERMAILING,ADpRESS; STREET 12,1 42) CITYk &a41 STATE (AAA ZIP q. 1,6 OWNERRHONE:: ri:CD OWNER.EMAIL: 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.CREQUIRED):GSHEAHC8218R ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 PRIMARY CONTACT: [DOWNER DICONTRACTOR DOTHER(Please Specify) CONTACT NAME: • CONTACT PHONE:425-252-4402 dawn weimer CONTACT EMAIL:dawn@gsheating.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and comsat. 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 COnstructlon. That lam authorized by the owner of this properly 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#: I A E Owner/Authorized Agent Signature Date' (Revised 1/11/2019) Page 1-Application _ _