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ELECTRICAL PERMIT APPLICATION
<br /> _ g CITY OF EVERETT PERMIT SERVICES
<br /> �'41171-
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits
<br /> PROJECT SI,TE,,INFO:RMATION
<br /> PROJECT ADDRESS: 129 112TH ST SE BUILDING AREA: 2462 sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ✓❑REMODEL
<br /> BUILDING USE: ❑✓ SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> ..s,; , ,,„r. .ELECTRICAL APPLICATION;?INFORMATION,&,DESCRIPTION',OE WORK] ,` t. ry
<br /> CONTRACT PRICE OF WORK:$ 4759.84 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE 100 AMP OVERHEAD SERVICE WITH 200 AMP
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO YES-Select Scope: ❑Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? ✓❑NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom El Thermostat El Audio El Secure Access ❑ Security System
<br /> ❑Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> ❑Other(List All): y� ■
<br /> t ! s 'i , �, _�+ i f i�: a CODE.1�iONIRLIANCE'=, j4d n tit r S,i O.O?.,�a.,v:' t s ...t .', n,t�.,1; y ..
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: �NO ❑YES--See Below&Pg.2
<br /> LiI 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
<br /> u of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: 0N0 DYES-See Below&Pg.3
<br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease
<br /> without the proper electrical licensing and certification,or exemption.By checking this box, I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> :.! CONT kCT�INPORMATIO,N 9,Ings;e lg/ ti Z, oY.
<br /> OWNER NAME: RICHARD WAMPLER TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 129 112TH ST SE
<br /> cnY EVERETT STATE WA ZIP 98208
<br /> OWNER PHONE:425-345-8920 OWNER EMAIL:KACERREX@HOTMAIL.COM
<br /> CONTRACTOR NAME: GS HEATING, COOLING&ELECTRICAL LLC
<br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE
<br /> CITY EVERETT STATE WA ZIP 98201
<br /> CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:SARA@GSHEATING.COM
<br /> CONTRACTOR LIC.#(REQUIRED):GSHEAHC8218R CITY OF EVERETT BUSINESS LIC.#(REQU1RED):60058
<br /> PRIMARY CONTACT: ❑OWNER ZCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-610-4257
<br /> SARA HOLLAND CONTACT EMAIL:SARA@GSHEATING.COM
<br /> 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
<br /> 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
<br /> 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
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC City of Everett Official Use Only
<br /> PERMIT#:
<br /> )1OJr .Q� / ��(� E
<br /> Owner Au o ized gent Signature Date (Revised 1/11/2019) Page 1-Application
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