9312 1ST AVE SE 2019-07-24 - Laserfiche WebLink

^:.ECTRICAL PERMIT APPLtATION 32 EVERETT CITY OF EVERETT PERMIT SERVIGL 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov( www.everettwa.gov/permits PROJECT SITE INFORMATIONi PROJECT ADDRESS: 9312 1ST AVE SE BUILDING AREA: 1272 sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ ADDITION ❑TENANT IMPROVMENT REMODEL BUILDING USE: EJ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL -„ ..ELECTRICALaAPPCICATION INFORMATION,8:DES'CRIP�TION>OF=WORK , CONTRACT PRICE OF WORK: $ 1068.35 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: REPLACE UNDERGROUNDED PLUGS WITH 2-PRONG PLUGS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO EYES-Select Scope: ❑ Service El Feeder ❑✓ Circuits-#:2 ❑ Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO Cl YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio ❑ 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 C„OMPLIINCE` IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO El 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: ENO EYES-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, 1 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:INF.,,,.ORMATION OWNER NAME: RANDY SONGSTAD TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr 9312 1ST AVE SE CRY EVERETT STATE WA ZIP 98208 OWNER PHONE:425-320-8491 OWNER EMAIL: CONTRACTOR NAME: GS HEATING CONTRACTOR ADDRESS: STREET3409 EVERETT AVE CITY EVERETT STATE WA Z,P 98201 CONTRACTOR PHONE:425-61 0-4257 CONTRACTOR EMAIL:SARA@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 PRIMARY CONTACT: 7OWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-61 0-4257 SARA HOLLAND CONTACT EMAIL:SARA@GSHEATING.COM AGREEMENT:l 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 ROW and 296200 WAC. City of Everett Official Use Only PERMIT#: A IA E111al6- 1, 02 owner/Authorize Age Signature Date (Revised 1/11/2019) Page 1-Application