5309 S 3RD AVE 2019-07-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION �� CITY OF EVERETT PERMIT SERVICES 1113200 CEDAR STREET,EVERETT,WA 98201 (P)425-257.8810 I FAX 425-257-8857 I(E)everetteps@overettwa.gov I www_everettwe.gavipermits PROJECT ADDRESS: 5309 S 3RD AVE BUILDING AREA: 1642 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL z Ef ECTRIICAL':AP;P151GATION"INFO,RMATION & DE$CRIP_T;IONtO WORK CONTRACT PRICE OF WORK:$ 800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: NEW CIRCUIT AND GFCI FOR A/C AND HEAT PUMP INSTALL THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? C-1 NO ✓❑,/YES-Select Scope:CI Service CI Feeder ED Circuits-#: 2 ❑Complete Re-wire LOW VOLTAGE WORK? Cl ,— NO I YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom El Thermostat ❑Audio ❑Secure Access ❑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, Other(List All): y D.„ C GJSA X1.(NCci, r"' w �f).'YL7tivA wt:.Va �Vq'. 1 .+�s I iN rKk3o`s�ya�c*�:....4P '.- � ..:...:. .,_,:I� ;'a�;�..}; �� `�'`"�.�r.�C.ODE�GDMPLlANCEr�.��-"�u,., 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ©NO 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.OWNER NAME: BEN THEW TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5309 S 3RD AVE crry EVERETT 37ATE WA ZIP 98203 OWNER PHONE:509-263-0306 OWNER EMAIL: CONTRACTOR NAME: GREENWOOD HEATING CONTRACTOR ADDRESS: STREET$25 S STACY ST cnv SEATTLE sTATE WA 98134 CONTRACTOR PHONE:206-784-1818 CONTRACTOR EMAIL:PERMITS@GREENWOODHEATING.COM CONTRACTOR LIC.#(REQUIRED):GREENHA922U7 CITY OF EVERETT BUSINESS L1C.#(REQUIRED):043985 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206_784.-1 8 1 8 TON I CARLSON CONTACT EMAIL:PERMITS@GREENWOODHEATING.COM AGREEMENT:t hereby certify that I have mad and examined this application and know the same to be true and correct. All provisions of taws 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 1 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#: TONI CARLSON ��74,1,00,,k,--, 3/29/2019 E 1 610 15 " Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application