906 SE EVERETT MALL WAY POLYWORKS 2019-09-05

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 'FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:906 SE Everett Mall Way Suite 120 Everett WA 98208 PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT E REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL BUILDING AREA: 1200 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$6000.00 (ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑NO ✓❑YES-#OF DEVICES:8 IS THIS A FIRE ALARM PERMIT? ❑✓ NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Electrical including (14)receptacles, (1)connection to hwt,adding(2)occupancy sensors, relocating existing lighting, adding (2) new exit signs, adding new CAT 6 cable drops, and installing(1) new 24port patch panel. IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑NO ❑YES--See Below&Pg.2 I I I 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:ENO 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(If Commercial): Polyworks OWNER MAILING ADDRESS: srREEr906 SE Everett Mall Way Suite 120 clTr, Everett • STATE WA ZIP 98208 -� �-� - OWNER PHONE: (OWNER EMAIL: " ' Pro-Tech Electric, inc. CONTRACTOR NAME: ' Ave BonnevilleCONTRACTOR ADDRESS: STREET 1126 - � \ I. clry Snohomish 0 f' ' STATE WA ....!: .:ZIP ,✓'`.... CONTRACTOR PHONE:425.334.9844 'CONTRACTOR EMAIL:iTbentem@pro-techelectric.com L .. >'/ CONTRACTOR LIC.#(REQUIRED):PROTETE934JC ICITY OF EVERETT BUSINESS LIC.#(REQUIRED) ' 055041' �_. PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify):' CONTACT NAME: CONTACT PHONE:425.334.9844 Taylor CONTACT EMAIL:Tbentem@pro-techelectric.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/aws;and'ordinances I governing this type of work will be completed whether specified herein or not. The granting of,a%permit does not presume,tp give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction::,That.1 am:authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC i;t nu City of Everett Official Use Only PERMIT# � �� i1 \Pi cot er/AuthoriredAgent Signature Date :,--(Revised-1:1/5/2018) Page 1-Application \ct,e_ E