332 SW EVERETT MALL WAY NATIONAL GENERAL INSURANCE 2019-09-05

CLECTRICAL PERMIT APPLit;ATION 4reerrCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PR® = "777 = RMATION �� R PROJECT ADDRESS: 332 SW Everett Mall Way, Bldg A, 98204 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATIQ••,`>- FORMATION &ES IPT1:ON QF WORK CONTRACT PRICE OF WORK:$ 1,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 16713 1911481 -One circuit for (5) card readers THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ✓❑YES-Select Scope: ❑ Service El Feeder ✓❑ Circuits-#: 1 El Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom El Thermostat ❑ Audio ✓❑ Secure Access El 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. ❑ Other(List All): e. . . .. COMPLIANCE ... � ,.. 'Vis• � \�' , 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: 17N0 DYES-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. �yt�. .a �.. `�� e:. ONTTACT INF RATION OWNER NAME: CBRE TENANT BUSINESS NAME(If Commercial): National General Insurance OWNER MAILING ADDRESS: STREET 332 SW Everett Mall Way Everett STATE WA ZIP 98204 OWNER PHONE:425.455.8500 OWNER EMAIL: CONTRACTOR NAME: Titan Electric CONTRACTOR ADDRESS: STREET 12828 Northup Way Suite 205 CITY Bellevue STATE WA Zip 98005 CONTRACTOR PHONE:206.633.2811 CONTRACTOR EMAIL:Permits@titanelectric.net CONTRACTOR LIC.#(REQUIRED):TITANEI963OB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51191 PRIMARY CONTACT: EOWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206.633.2811 Jon Osborn CONTACT EMAIL:permits@titanelectric.net 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#: Digitly signed by David Crook David Crook DN C=US,E davdcatitanelectric net E ii n O Titan Electric CN=Dav d Crook -may/ Date,12019.03121045:370700' 5/23/2019 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application