1715 BROADWAY 2019-09-04 - Laserfiche WebLink

ELECTRICAL PIP2MIT & FIRE ALARM Pt4IT APPLICATION CITY OF EVERETT PERMIT SERVICES '.1/%1!---72773200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROEC '"SITE I FORMATIOI+I PROJECT ADDRESS: 1--- -?:,i'o WNl/1' PROJECT TYPE: ['NEW CONSTRUCTION 0 ADD ION TENANT IMPROVMENT REMODEL BUILDING USE: ❑ISFR 0 TOWNHOUSE 0 DUPLEX �4DU 0 w1ULTI-FAMILY-#OF UNITS: lia COMMERCIAL BUILDING AREA: sq ft �+M 1.01II it t 0 rA `to ` ;Ik #6 tet, ....,..: ,., ...., , �.. ,L 4, ,. U,. _, .,, .... .. ,. .. ,. , ,, 7 ., a •_ CONTRACT PRICE OF WORK: $2,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO ❑ YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? ia NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION Ol WoR A CODE COMP IANGE DESCRIPTION OF WORK: Power for Bakery Island refrigeration case THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LcBychecking 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 INFORNMATION OWNER NAME: Safeway TENANT BUSINESS NAME(If Commercial): Safeway OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: D&R Electrical Services CONTRACTOR ADDRESS: STREET 2598 SW Pine Rd Cry Port Orchard STATE WA ZIP 98367 CONTRACTOR PHONE:3602713112 CONTRACTOR EMAIL: dandrelectricO912@gmail.com CONTRACTOR LIC.#(REQUIRED) DRELEE*826BE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): F PRIMARY CONTACT: p DWNER CONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3602713112 Dave Hall CONTACT EMAIL: dandrelectric0912@gmail.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 lb , PERMI1r Mir '2 _ ,, 1 nr/Authorized Agent Signature Date (Revised 10/30/2018) age 1 of 3l