5505 EVERGREEN WAY ABRA AUTOBODY AND GLASS 2019-09-05

so az I ECTRICAL PERMIT APPLI TION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.goy/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 5505 Evergreen Way BUILDING AREA: 5400 sq ft PROJECT TYPE: I NEW CONSTRUCTION 1 ADDITION ��TENANT IMPROVMENT L REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: Q COMMERCIAL ELECTRICAL APPLICATION INFORMAIION&,DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 6500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Upgrade a 200A single phase service to a 200A 3 phase service. No additional loads THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 7 YES-Select Scope: 7 Service ❑ Feeder El Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): C Data ❑ 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. ❑ Other(List All): CODE COMPLIANCE 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: L7_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 licensingicertification requirement. z ,iri014A1TACT INFORMATIONn'. OWNER NAME: ABRA INC TENANT BUSINESS NAME(If Commercial): ABRA Auto Body and Glass OWNER MAILING ADDRESS: STREET 7225 Northland Drive#210 ,,n Brooklyn Park STATE MN z,, 55428 OWNER PHONE:763 561-7220 OWNER EMAIL:Everett@abraauto.com CONTRACTOR NAME: Brack Electric LLC CONTRACTOR ADDRESS: STREET 1024 Utsalady Road carr Camano Island STATE WA „p 98282 CONTRACTOR PHONE:360 672-1684 CONTRACTOR EMAIL:Brackelectric@gmail,com -: -1's% . ii �J CONTRACTOR LIC.#(REQUIRED):BRACKEL923DP CITY OF EVERETT BUSINESS LIC.#(REQUIRED): See License Receipt PRIMARY CONTACT: DOWNER ®CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360 672-1684 Riley Brack CONTACT EMAIL:brackelectric@gmail.Com AGREEMENT:f 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, comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 2 , 94 Owner/Ant rized Agent Signature D e (Revised 1/11/2019) Page 1-Application