5711 12TH AVE W 2019-07-09 - Laserfiche WebLink

RECTRICAL PERMIT APPLICATION grrCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everelteps@everettwa.gov I www.everettwa.govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: 5711 12th Ave Witt( (— BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑✓ SFR ❑TOWNHOUSE El DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS; ❑ COMMERCIAL '.'ELECTRICAL APPLICATION. INFORMATION 13$ OF WORK CONTRACT PRICE OF WORK:$ 900.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: disconnect/reconnect gas furnace THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑NO 0 YES-Select Scope: El Service 0 Feeder ❑Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO El YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑Data El Intercom 0 Thermostat 0 Audio El Secure Access ❑Security 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. Other(List All):disconnect/reconnect gas furnace CODE'.COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO ❑YES—See Below&Pg.2 Iri I By checking this box,I am stating that I have read and understand all of WAC 286.46E-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: ONO OYES-See Below&Pg.3 flPursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease �J 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: Eric Grieve TENANT BUSINESS NAME(If Commercial):NA OWNER MAILING ADDRESS: STREET 5711 12th Ave W#B are Everett STATE VV►nj A z,P 98203 OWNER PHONE:425-330-6989 OWNER EMAIL: CONTRACTOR NAME: Greenwood Heating &AC CONTRACTOR ADDRESS: sTREET825 S Stacy ST cry Seattle STATE WA ZIP 1134 CONTRACTOR PHONE:206*784-1818 CONTRACTOR EMAIL:permits@greenwoodheating.com CONTRACTOR LIC.#(REQUIRED):GREENHA922U7 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED .43985 PRIMARY CONTACT: ['OWNER ZCONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-784-1818 Please see contractor CONTACT EMAIL:permits@greenwoodheating.com AGREEMENT::f hereby certify that I have read 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 con auction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and t Comply with the Staff ontractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only PERMIT#: 4/10/2019 E k9OC4 �V Owner! uthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application