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ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov i www.everettwa.gov/permits <br /> 477 <br /> �� PROJECT SITE INFORMATION' `- '. <br /> PROJECT ADDRESS: 332 SW Everett Mall Way <br /> PROJECT TYPE: INEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: p COMMERCIAL <br /> BUILDING AREA: sq ft <br /> 1.04S",‘"`. ELS` PUCAlON INFOR -1P';' n., 5 -4111:A:11 <br /> CONTRACT PRICE OF WORK:$ 435.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? l0 NO ❑ ES-#OF DEVICES: __ <br /> IS THIS A FIRE ALARM PERMIT? 10 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: <br /> Retrofit 400w Metal Halide Fixture to LED. Titan Job#180439 WO 15478 <br /> THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: <br /> 1JBy 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ATTENTION OWNERS: THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> ® Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without <br /> the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Seattle Specialty Insurance TENANT BUSINESS NAME(If Commercial): same <br /> OWNER MAILING ADDRESS: STREET 332 SW Everett Mall Way <br /> CITY Everett STATE WA ZIP 98204 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Titan Electric Inc <br /> CONTRACTOR ADDRESS: STREET 12828 Northup Way, Suite 205 <br /> cm, Bellevue STATE WA zip 98005 <br /> CONTRACTOR PHONE: 2066332811 CONTRACTOR EMAIL: permits@titanelectric.net <br /> CONTRACTOR LIC.#(REQUIRED): TITANEI9630B CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 051191 <br /> PRIMARY CONTACT: ❑ OWNER 4 ;ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2066332811 <br /> Linda Anderson CONTACT EMAIL: permits@titanelectric.net <br /> 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 <br /> 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 <br /> 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 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> =Lind ' l.� y signed iLin@.d,taCitAnderson <br /> d AndvrsOlNecr,=cUCSo,mEp=alnnyaacaNnelLearicAnneerOsonTitan a ,'\ r O v <br /> by <br /> Owner/Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3 <br /> q....2.,) <br />