1402 SE EVERETT MALL WAY A T AND T 2019-09-05

ELECTRICAL PERMIT APPLIVuTION OLTCITY 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.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 402 SE Everett Mall Way BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 600 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install two internally illuminated wall signs on the tenant's northeast and northwest exterior elevations. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El 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):Sign installation(connect to existing sign circuit). CODE COMPLIANCE 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-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: ❑✓ NO 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Brixton Everett LLC TENANT BUSINESS NAME(If Commercial): AT&T OWNER MAILING ADDRESS: STREET 120 S Sierra Ave CITY Solana Beach STATE CA ZAP 92075 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Culbertson Sign Service CONTRACTOR ADDRESS: sTREET 5209 122nd St E CITY Tacoma STATE WA ZIP 98446 CONTRACTOR PHONE:253-538-0752 CONTRACTOR EMAIL:csspermits@gmail.com CONTRACTOR LIC.#(REQUIRED):CULBESS984MU CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053695 PRIMARY CONTACT: ❑OWN ER ILICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-538-0752 Hans Visser CONTACT EMAIL:csspermits@gmail.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 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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: tid Y 03/21/2019 E 01 U� Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application