710 SE EVERETT MALL WAY GROCERY OUTLET 2019-09-05

ELECTRICAL PERMIT APPLICATION 4677CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits ' PROJECT SITErINFOR{YMA`TIO.i _, PROJECT ADDRESS: 710 SE Everett Mall Way BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: El SFR ❑ WNHOUSE 0 DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL 1 ' _ �ELEG3Ti .AL;APPLLI: A�TION11INFORMArION,AIDESCR.IP�1 IONOFr,`IViORK CONTRACT PRICE OF WORK: 1200.00 1 ASSOCIATED BUILDING PERMIT#(if applicable): S DESCRIBE SCOPE OF WOR : (1) 120v 20 amp circuit for ole THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope:❑Service ❑ Feeder ✓❑Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ✓❑Thermostat ❑Audio ❑ Secure Access ❑Security System ❑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): = ._ _ T..�. : __—. - .- . ___ ____ .._ _v__ . - IS THIS PERMIT EDUCATION, _ _....__ ..._ INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO ❑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. rr�� DYES ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: IJNO YES-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. F..7 ; ..- t. r,: , , ,r,-.,; '`CON!IVACiI INFORMATION1._. L..,_L.__.. - __ITT ___ . . OWNER NAME: Grocery OUley TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: /// sTREeT 710 SE Everett Mall Way Cm, Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: SeaTac Electric CONTRACTOR ADDRESS: sTREET7056 S 220th St cry Kent STATE WA z,P 98032 CONTRACTOR PHONE:2538725553 CONTRACTOR EMAIL:frani.schriner@seatacelectric.com CONTRACTOR LIC.#(REQUIRED):SEATAEI077RW CITY OF EVERETT BUSINESS LIC.#(REQUIRED):033037 PRIMARY CONTACT: DOWNER ['CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-638-7513 Frani Schriner CONTACT EMAIL: 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 w. 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 ulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and! comply)tel h the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /I 4 • E ck)ick - --Loc 0 `:riAuthorized Agent Signature ll ate (Revised 1/11/2019) Page 1-Application 1