1921 COLBY AVE 2019-08-07 - Laserfiche WebLink

ELECTRICAL FERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits 47477 PROJECT SITE INFORMATION:, PROJECT ADDRESS: 1921 COLBY AVE PROJECT TYPE: 2NEVV CONSTRUCTION ❑❑ADDITION ❑TENANT IMPROVMENT REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL BUILDING AREA: 2880 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 1❑ NO 0 YES-#OF DEVICES: 2 IS THIS A FIRE ALARM PERMIT? qu NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK &rCODE COMPLIANCE DESCRIPTION OF WORK: running two stat wires for new con C � -____i F THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: -1:- By 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. ATTENTION OWNERS: THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ® 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: HUDSON RYAN E & KIRSTEN A TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3504 MISSION BEACH RD CITY TULALIP STATE WA zip 98271 OWNER PHONE: 425-374-9409 OWNER EMAIL: CONTRACTOR NAME: G&S Heating CONTRACTOR ADDRESS: STREET 3409 Everett Ave cin, Everett STATE WA Zip 98201 CONTRACTOR PHONE: 425-309-6507 CONTRACTOR EMAIL: Jonathan@gsheating.com CONTRACTOR LIC.#(REQUIRED): GSHEAC*939RK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19685 PRIMARY CONTACT: ❑ OWNER 13ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-309-6507 Jonathan Farrell CONTACT EMAIL: Jonathan@gsheating.com gsheating.Com AGREEMENT:I 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 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 12-5-18 E l2 ( 2 - 0 O�a ��z wner/Authorized Agent Signature Date (Revised 10/30/2018)