530 SW EVERETT MALL WAY JUDD AND BLACK 2019-09-05

F! FCTRICAL PERMIT APPLYAtTION re. CITY OF EVERETT PERMIT SERVICE 3200 CEDAR STREET, EVERETT,WA 9ozui (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 510 SW Everett Mall Way BUILDING AREA: 22,700 sq ft PROJECT TYPE: NEW CONSTRUCTION ❑ ADDITION III TENANT IMPROVMENT H REMODEL BUILDING USE: I SFR 7 TOWNHOUSE ❑ DUPLEX ❑ ADU MULTI-FAMILY-#OF UNITS: ✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 22,717.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Hook up electrical signs on front of building facade to existing sign circuit. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? U NO ❑ YES-Select Scope: Service ❑ Feeder ❑ Circuits-#: I I Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data P Intercom ❑ 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. 7 Other(List All):Channel Letter Signs on raceways 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: I✓INO 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: Orion Alliance Group/Kirk Wong TENANT BUSINESS NAME(If Commercial): Judd & Black Appliance OWNER MAILING ADDRESS: STREET 2401 San Pablo Avenue, Suite 215 /+ C1TY Pinole STATE CA ZAP 94564 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Fastsigns- Everett. CONTRACTOR ADDRESS: sTREET2802 Colby Ave CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE:425.438.9350 (CONTRACTOR EMAIL:Duane.Steig@Fastsigns.com CONTRACTOR LIC.#(REQUIRED) � —10 LA CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: IOWNE' I✓iCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: l oh T CONTACT PHONE^e ZOC (-4(C2 g 3 lq_L1 i.— ii CONTACT EMAIL: (A,��-d2C w O\mc • AGREEMENT:I hereby certify that I have read and examined this application and know the same to be tr and correct. All rovisions of la\vs 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 tc violate or candel 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#: //z.3/2_0/ E ,\39--- Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application