6727 EVERGREEN WAY BIG LOTS 2019-09-05

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 4106/1"4 3200 CEDAR STREET,EVERETT.WA 98201 (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa gov www everettwa gov/permirs PROJECT SITE INFORMATION PROJECT ADDRESS: 6727 Evergreen Way BUILDING AREA:44 424 sq ft PROJECT TYPE: Li NEW CONSTRUCTION Li ADDITION 0 TENANTIMPROVMENT 0 REMODEL BUILDING USE: LII SFR El TOWNHOUSE El DUPLEX El ADU L.1 MULTI-FAMILY-#OF UNITS: El COMMERCIAL cTRscL AppugApoN INFQ4MATI,C11,,St DESCRIPTIWCIF,WORK'NW„,,,,v, CONTRACT PRICE OF WORK:$ 150,000 ASSOCIATED BUILDING PERMIT#(if applicable). DESCRIBE SCOPE OF WORK: Relocat 3 Panels, New Lighting and power devices THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? [I]NO YES-Select Scope: LI Service El Feeder El Circuits-#: WTI Complete Re-wire LOW VOLTAGE WORK? NO E YES-#of Devices SELECT SCOPE(REQUIRED) Li Data 0 Intercom Li Thermostat Li Audio El Secure Access ti Security System 0 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. E Other(List All): CODE COMPLIANCE 1,, IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 7NO 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: 'ENO OYES-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 OWNER NAME: Big Lot Stores TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4900 E. Dublin Granville Rd Columbus OH z 43081 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: OMB Electrical Contractors LLC CONTRACTOR ADDRESS: STREET PO Box 14693 Mill Creek STATE WA 98O,8 CONTRACTOR PHONE: CONTRACTOR EMAIL: G b20(-4L1 j2\ r CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIR ): *Vs? PRIMARY CONTACT: DOWNERiNECONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-248-8726 Barney Cabua CONTACT EMAIL: DafTleygOrCaeCi1C.COM AGREEtiENT 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 lam 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 RCWand 296 200 WAG. City of Everett Official Use Only PERMIT#: E - Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application