906 SE EVERETT MALL WAY POLYWORKS 2019-09-05

III / ELECTR CCAL PERT APPLICA II 110N CITY OF EVERETT PERMIT SERVICES ,,,,, "' 3200 CEDAR STREET,EVERETT,WA 98201 �h��je __ __ (P)425-257-8810 FAX 425-257-8857(p (E)everetteps[@everrettwa.gopv({I www.everettwa gov/permits ',� -- — - G1 aJEC d - T -� IFO i'lil it` lCI['�f1K��x '� ------- — PROJECT ADDRESS: 6i0654i;Vf-Rt.1C MALL hoot #)-v (BUILDING AREA: IC `73 sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION yl,TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY #OF UNITS: COMMERCIAL _ ELECT EGAt l PPLECATfOR [INFORMATION ES3C PTE E OF *Mt — CONTRACT PRICE OF WORK:$ I5O0 tOO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Aboims h Doo lut ONirti` hti,N 101`It=VSCtis 10 111 L k.Xts15,4/b ifh.r ALA"- $ySivr. J THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 6 NO 0 YES-Select Scope: 0 Service 0 Feeder 0 Circuits-#: 10 Complete Re-wire LOW VOLTAGE WORK? 0 NO YES-#of Devices: 1 SELECT SCOPE(REQUIRED): 0 Data • Intercom 0 Thermostat 0 Audio 0 Secure Access LI Security System ire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. 0 Other(List All: CODE COMPUU.',NCE , IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO `' YES--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-91 0,selected the specific reason on page 2 Ii fl of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:rNO OYES-See Below&Pg. 3 --1 Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on b ildings for rent,sale, or lease without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORM TEOr ;OWNER NAME:..PrL.tiE (S. VLILin'tiNtDil6S LI-L TENANT BUSINESS NAME(If Commercial): ?c LI hflAk S OWNER MAILING ADDRESS: STREET '106 SE E.Va.I lT MAS WAy a iii CITY t=Vt.7�LS1,. STATE V�''< ZIP 610$ OWNER PHONE: OWNER EMAIL CONTRACTOR NAME: W4.51EPN $1Ait5 Fitt ji31tcitoK CONTRACTOR ADDRESS: STREET 19180 !V6 4511\ St *lot y4 STATE WA ZIP 413iY, clTv �Enl*y rvp CONTRACTOR PHONE: q).1-1/6‘,0,10 CONTRACTOR EMAIL: SE.M.7. :NNDf 6)1�Sf P,J 5 CONTRACTOR LIC.#(REQUIRED): l+,,)•;L,F qaP CITY OF EVERETT BUSINESS LIC.#(REQUIRED): )05;3 V\ PRIMARY CONTACT: 0 OWNER C ..CONTRACTOR 0 OTHER(Please Specify) O` (CONTACT NAME: CONTACT PHONE: 1+,5,41%_4110g �(l-D 5JP-\ LA AA CONTACT EMAIL: 5�1K,3,t=yrva=k 6/Vois ' ' . J -. AGREEMENT:!hereby certify that!have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing-tfiis 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 City of Everett Official Use Only comply with the State Contractors Law 18.27 RCW and 296.200 WAC. PERMIT#: 7 _�� E '`�, 0 2 - OL-{O OwnerlAuthoriz Agent Signature Date (Revised 1/11/2019) Page 1-Application