6726 EVERGREEN WAY KEY BANK 2019-09-05

mow ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHkNGTON (P)425.237-8810 I FAX 425-257-8857 1(E)evaretteps©everattwa.gov I www.everettwa.gov1pemiits )�ROJLAT iN +�RIYI,ATION n.w,nor ....,. PROJECT ADDRESS: 6726 Evergreen Way,Everett, WA 98203 IBUILDING AREA: NlA sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT CI REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE ❑ DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL , E .r .: �... . : ... y OTRICJaA)PPLiCAON NFQRMATION"&`0C..RiraoN an1ffo CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(If applicable): N/A DESCRIBE SCOPE OF WORK: Install 1 new exterior lighting pole and fixture, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ✓❑YES-Select Scope:El Service El Feeder Circuits-# 1 ❑Complete Re-wire LOW VOLTAGE WORK? NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access El 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): a _ .-' ,77 r -CODECOMIPLIANCIV (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 296468-900,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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:t1NO DYES-See Below&Pg.3 f{ Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I 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: Key Bank TENANT BUSINESS NAME(If Commercial):Key Bank OWNER MAILING ADDRESS: sTREI:T 6726 Evergreen Way c,,.,, Everett STATE WA n,98203 OWNER PHONE:(425) 353-6550 OWNER EMAIL:N/A CONTRACTOR NAME: Seahurst Electric, Inc. CONTRACTOR ADDRESS: 5182 ;.2915 Chestnut St. crry Everett STATE WA np 98201 CONTRACTOR PHONE:(425) 258-1882 1CONTRACTOR EMAIL:dleblanc@seahurst.com CONTRACTOR LIC.#(REQUtRED):SEAHUE1099QN CITY OF EVERETT BUSINESS UC.*REQUIRED):18763 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425) 258-5143 Dave LeBlanc cONTACTEMAIL:dleblanc@seahurst.com AGREEMENT.t hereby certify that 1 have read and examined this application and know the same to be true and correct. Ail provisions of laws and ordinances governing this type of work wilt 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 authorised by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1B 27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 72619 E \\ Vk \ Owner/Autho Agent Signature Date (Revised 1/11/2019) Page 1-Application