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07/15/2019 13:55 FAX 425 377 1976 REX ELECTRIC 4 Everett Permits a 001 <br /> ELECTRICAL FRMIT & FIRE ALARM P!MIT APPLICATION <br /> T ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 4rEn- <br /> ..................................................... .:.:. .. ................................... .. <br /> ............................................ :.:: .....................................:......:ROJEC 'SI"F. IN ORM.M 'IoN..................................................................................................... <br /> PROJECT ADDRESS: 811 verett Mall Way <br /> PROJECT TYPE: =NEW CONSTRUCTION =ADDITION C ]TENANT IMPROVMENT =REMODEL <br /> BUILDING USE: [].SFR 0 TOWNHOUSE =DUPLEX ❑'�'1-DU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> BUILDING AREA: N/A sq ft <br /> ::...........................................................:::: .................. . :: <br /> EL G::TRICAL.APPLICATION INFORMA:TION <br /> ......................................................... .. ........................... .. ............ ...... .................. ............................... .... ....................................................................................................................... <br /> CONTRACT PRICE OF WO : $ 5,700 'ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE W RK? D N 0 YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PER T? 0 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTII ONIOVVItORIVIVCOPEIICOMPLIANCE............................................................................. <br /> ................................................................................. ................ ........... ... .................................................................................... ... ......................................................................................... <br /> DESCRIPTION OF WORK: Replace pole lights, wall packs and soffit cans with LED lights <br /> THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> la 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 /> 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 /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> Ell <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent, sale,or lease without <br /> the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> . ........ . .. ... ........... . .......... .CON'TAC r INFORMATION..... ... ............. .......... .... ... ...... ... ......... <br /> OWNER NAME: RMD properties TENANT BUSINESS NAME(If Commercial): Trader Joes &Other <br /> OWNER MAILING ADDRESS: STREET PO Box 261 <br /> CITY Redmond STATE WA zip 98073 <br /> OWNER PHONE: 206-992-7334 'OWNER EMAIL: rmdproperty@hotmail.com <br /> CONTRACTOR NAME: Rex Electric Service Inc. <br /> CONTRACTOR ADDRESS: STRELi 11112 18th ST NE <br /> CITY STATE Stevens STATE WA ZIP 98258 <br /> CONTRACTOR PHONE: 425-422-1744 CONTRACTOR EMAIL: rriecks©gmail.com <br /> CONTRACTOR LIC.#(REQUIRED): REXELES962N4 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 48749 <br /> PRIMARY CONTACT: DWNER PTONTRACTOR =OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-422-1744 <br /> Robin Riecks CONTACT EMAIL: rriecks@gmail.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 <br /> 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 <br /> provisions of any other state or local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /.2.96 /6 7-15-19 .s`l © --`OA <br /> Owner/Authorized Agent Signature Date (Revised 10/30/2018) .Rages <br />