1000 SE EVERETT MALL WAY US CENSUS BUREAU 2019-09-05

.ECTRICAL PERMIT APPL kTION A..rCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwagov/permits a_. ."_ ,x 1. kINFORMATION PROJECT ADDRESS: 1000 SE Everett Mall Way BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION-& DESCRIPTION OF WOR , ? n CONTRACT PRICE OF WORK:$ 43000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install network cable, security system and new receptacles, relocate existing lights THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO Q YES-Select Scope: El Service El Feeder ❑Circuits-#:21 ❑ Complete Re-wire LOW VOLTAGE WORK? C NO ❑✓ YES-#of Devices:91 SELECT SCOPE(REQUIRED): El Data ❑ Intercom El Thermostat El Audio ❑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. [Ti Other(List All): ,: ► OMPU,lANCE ,, ,., - IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 7 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: RIND EYES-See Below& Pg. 3 II 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. 6:: . "I`INFORt MA `I .., - W. OWNER NAME: Colliers ` TENANT BUSINESS NAME(If Commercial): GSA Census Bureau OWNER MAILING ADDRESS: STREET 6500 Harbor Heights Parkway St. 107 crry Mukilteo STAB wa ZIP 98275 OWNER PHONE:425-315-1354 OWNER EMAIL: CONTRACTOR NAME: American Electrical Contractors inc CONTRACTOR ADDRESS: STREET 13550 39th ave ne .Seattle STATE wa zip 98125 CONTRACTOR PHONE:206-67579 CONTRACTOR EMAIL:BILL.MAHONEY COMCAST. @ NET �^.- , CONTRACTOR LIC.#(REQUIRED):AMERIEC923KF CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 53749 PRIMARY CONTACT: DOWNER RCONT'ACTQR COTHER(Please Specify) CONTACT NAME: ` CONTACT PHONE:206-679-7579 bill mahyCONTACT EMAIL:bill.mahone comcast.net AGREEMENT t hereby certify that t have read and examined this application and know the same to,be trueand 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 l am authorized by the owner of this property to perform the work for which application is made and t comply with ttts-.tate Contractors Law 18.27 ROW 296.200 WAC. City of Everett Official Use Only 1 : _ -�. / PERMIT#: ,,( E1,90 O 3 Oner/Authorized Agent Signatt a Date (Revised 1/11/2019) Page 1-Application