7920 EVERGREEN WAY 2019-09-05 - Laserfiche WebLink

ELECTRICAL PERMIT APPLI( f ION OrETTCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7920 EVERGREEN WAY BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 1 ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 800.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Extend existing circuit to qty(4) freestanding menu signs. Connect menu signs. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ 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. tJ Other(List All): 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. �; EYES YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: I VINO 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: ARCHLAND PROPERTY I LLC TENANT BUSINESS NAME(If Commercial): MCDOnalds OWNER MAILING ADDRESS: STREET 2711 CENTERVILLE ROAD #400 cITY WILMINGTON STATE DE ZIP 19808 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Mixign Inc dba Shoreline Sign & Awning CONTRACTOR ADDRESS: STREET 12101 Huckleberry Lane CITY Arlington STATE WA ZIP 98223 CONTRACTOR PHONE:36O-435-2013 CONTRACTOR EMAIL:mallory@shorelinesign.com CONTRACTOR LIC.#(REQUIRED):SHORESA9821W CITY OF EVERETT BUSINESS LIC.#(REQUIRED):40921 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:p CONTACT PHONE:360-435-2013 Mallory Potter CONTACT EMAIL:mallory@shorelinesign.com 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 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 I comply with the State Contractors Law 18.27 RCWj)and 296.200 WAC. City of Everett Official Use Only PERMIT#: 2/6/19 E kckoz " Os Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application