1008 LOMBARD AVE 2019-07-24 - 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE,'iNFORMATION.:: PROJECT ADDRESS: ?, ^,` ; t-,1:1;1 BUILDING AREA: sq ft PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION LSI TENANT IMPROVMENT CIREMODEL BUILDING USE: LTJ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNiTS: ❑COMMERCIAL ;.ELECT.RI.CAL AP.PLICATIONINFO:RMATION`&';DESCRIPTION`O,F,WORK CONTRACT PRICE OF WORK:$ 0 ASSO,,CIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: P% p Y\ Q THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE ORK? [�, , p ;❑Service' ❑':Feeder ❑Circuits-#: ❑ Complete Re-wire W._.. ❑NO YES..-Select Sco e; LOW VOLTAGE WORK?, ❑.No YES #ofD:evlces; SELECT SCOPE(REQUIRED): El Data ❑l:nterconi `<Thermostat ❑Audio ❑Secure Access El Security Systeme ❑ 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: © NO ❑YES—See Below&Pg.2 nBy 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 DYES-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:INFORMATI ON, OWNER.NAME:; .i!r�J: _ ,��,ix TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS:; STREET y< ?, Ear A\c- ?Jjc - ,-e CITY P/tiL STATE 'tZIP Cl'.l Com')u - OWNER PHONE: I,A i,�--7) k(y) i i - OWNER:EMAIL CONTRACTOR NAME: gs heating CONTRACTOR ADDRESS: sTREET3409 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: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 dawn weimer CONTACT EMAiL:dawn@gsheating.com AGREEMENT.'/hereby certify that I have read and examined this application and know the same to be true and correct. Ail 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 1 am authorized by the owner of this property to perform the work for which application is made and l comply with tqe State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: E clOS -- o Owner/Authorized Agent Signature D'ate (Revised 1/11/2019) Page 1-Application