500 SE EVERETT MALL WAY B BASE FILE 2019-09-05

i tilLECTRICAL PERMIT APPI_- TION E CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 500 SE Everett Mall Way BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION 0"TENANT IMPROVMENT [}REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: Q COMMERCIAL ELECTRICAL APPLICATION INFORMATION& SC +1F'ION"- CONTRACT PRICE OF WORK:$:),1.13001:5r) 5500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replacement of thirteen (13) Roof top units across Building A and Building B, LIKE FOR LIKE REPLACECEMENT WITH REDUCED/SAME LOAD. NEW DISCONNECTS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE':t(SELECT ALL THAT'APPLY) UNE VOLTAGE WORK? ❑NO ❑✓ YES-S.elect.S.cgpe:❑Service ❑:'Feeder ❑Circuits-#:43 121.CompleteRe-wire LOW VOLTAGE WORK? 0 NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio El Secure Access ❑Security System El 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 COMPLIANCE, - IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: J❑ 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: ❑NO 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, I 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 INFORMATION I OWNER NAME:JKL Real Estate TENANT BUSINESS NAME(If Commercial): OWNER MAIUNG ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: MBE ELECTRIC CONTRACTOR ADDRESS: sTREET12002 SE 91st ST CITY Newcastle STATE WA 98056 CONTRACTOR PHONE:253-3324072 ,CONTRACTOR EMAIL:mbeelectrlc@hotmail.com CONTRACTOR LIC.#(REQUTRED):MBEELEL874 0 CITY OF EVERETT BUSINESS LW.#(.REQUIRED): 053568 PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: I CONTACT PHONE:253-332-4072 Mike`e CONTACT EMAIL: mbeeleCtriC@h0tmaiLCOm AGREEMENT:/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 witt atte St.n• . ,.,r. Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only //j PERMIT#: ��- 05113/19 r E Ic 05 -- o —k :• :r/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application