Fillable Electrical Permit Application (City of Sammamish)

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Electrical Permit Application (City of Sammamish)

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LAND USE APPLICATION SMC 16.05.153
Electrical Permit Application
Page 1 of 2
Updated 6/30/2017
Department of Community Development
801 228th Avenue SE
Sammamish, WA 98075-9509
Phone: 425-295-0500
Fax: 425-295-0600
Web: www.sammamish.us
www.mybuildingpermit.com
Electrical Permit Application
Complete this form to submit at City Hall or submit online at mybuildingpermit.com.
Prior to submitting this application, use the corresponding Electrical Permit Checklist to verify that
other required forms and submittal documents are provided for a complete permit application.
Property Information
Permit Information
Electrical Contractor Information
Primary Contact Information
Property Address:
Tenant (if Commercial):
Property Owner:
Owner Address:
Parcel Number(s):
Project Name:
Owner Phone:
Permit Number:
The proposed work is for:
Line voltage only Low voltage only Both
This electrical permit relates to:
(select one)
Single Family, Duplex, or Townhouses (Residential Only)
Mixed use Multi-Family (Residential Only)
Commercial or Industrial (Non-Residential)
The proposed work will be located:
Interior only Exterior only Interior & Exterior
Estimated cost of electrical work only (fair market value, labor, & materials):
Description of work to be done:
Related permits (if any):
Contractor Name:
Contract Name:
Contractor Phone:
Contractor E-mail:
Mailing Address:
Contractor’s L&I License #:
Contractor’s WA State UBI #:
Owner is Contractor
I have read, signed, and am now submitting the Property Owner/Renter/Lessee Affidavit per RCW
19.28.261.
Owner/Agent Printed Name:
Owner/Agent Signature:
Date:
Electrical Permit Application
Page 2 of 2
Updated 6/30/2017
Supplemental Electrical Information
Will the proposed electrical work involve any of the following? (check all that apply):
Installation or alterations of service or feeders 100amps or more (other than 1 & 2 family)
Commercial generator installations or alterations (unless loads are cord and plug connected)
Educational, institutional, health, or personal care occupancies as defined in WAC296-46B-010(14)
Changing 60% or more of lighting fixtures and increasing lighting load
Installation of switches or circuit breakers rated 400 amps or more
Addition of 100 amps or more to an existing service or feeder
Hazardous areas as defined by NEC
Commercial vehicle changing stations – Number of stations:
Commercial generator installations or alterations (unless loads are cord and plug connected)
Note: If any of the above items have been marked, an electrical plan review will be required, and
electrical plans shall be provided with the Electrical Permit Application. See Electrical Permit Checklist.
Will the proposed electrical work involve any of the following? (check all that apply):
Photovoltaic (solar) panels – See Residential Solar Photovoltaic Systems Electrical Permit Checklist
Residential outdoor generator(s) – A separate Mechanical Permit is required.
Residential outdoor HVAC equipment – A separate Mechanical Permit is required.
Wireless facility
Note: If any of the above items have been marked, a planning review will be required, and plans for
outdoor equipment shall be provided with this application. See Electrical Permit Checklist.
Will the proposed electrical work involve any of the following? (check all that apply):
Carnival or Festival – Number of concessions:
Temporary power – Specify the number of Amps: 1 - 200 201 - 399 400 +
Pool, hot tub, spa, or sauna
Fire protection (Fire System Permit required for fire sprinkler/suppression, radio, or alarm systems)
Illuminated sign – A separate Sign Permit is required for installation of a new sign.
Acknowledgements
1. By signing this application, I authorize employees/agents of the City of Sammamish to enter onto
the property which is the subject of this application during regular business hours. The sole
purpose of entry is to make any examination of the property necessary to process this application.
2. I certify that I am the owner of this property or the owner’s authorized agent. If acting as an
authorized agent, I further certify that I have full power and authority to file this application and to
perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review
such application. I have furnished true and correct information. I will comply with all provisions of
law and ordinance governing this type of application. If the scope of work requires a licensed
contractor to perform the work, the information will be provided prior to permit issuance.
3. Per SMC 16.20.235, every permit shall expire 1 year from the date of issuance.
I hereby certify that I have read and examined this application and know the same to be true and
correct.
Owner/Agent Printed Name:
Owner/Agent Signature:
Date:
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Electrical Permit Application (City of Sammamish)

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Completed 24 January 2021

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