9423 EVERGREEN WAY NAPA AUTO PARTS 2019-09-05

ELECTRICAL PERMIT APPLIGA NON 47677- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-885557 Y■1(E)everetteps@everettwa.gov I www.everettwa.gov/permits .. .E.P . .. fOT .:IN MA PROJECT ADDRESS: 9423 EVERGREEN WAY BUILDING AREA: NOT SURE sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL : ... t ',",,NINFORMATION J►.DRSCRIPI ON OF WORKS CONTRACT PRICE OF WORK: $ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: SEPARATE EXISTING CIRCUIT TO MAKE THE FIRE ALARM BE ON IT'S OWN BREAKER. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service El Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access ❑ Security System El 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: ✓❑ 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: ENO 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: ROB COOGLE TENANT BUSINESS NAME(If Commercial): NAPA AUTO PARTS OWNER MAILING ADDRESS: STREET 9423 EVERGREEN WAY CITY EVERETT STATE WA ZIP 98204 OWNER PHONE:360-708-3877 OWNER EMAIL:COOgle9@aOI.COm CONTRACTOR NAME: ACKERMANN ELECTRIC COMPANY CONTRACTOR ADDRESS: STREET 1700 RAILROAD AVENUE CITY MOUNT VERNON STATE WA ZIP 98273 CONTRACTOR PHONE:360-336-6188 CONTRACTOR EMAIL:ACKERECO@FIDALGO.NET CONTRACTOR LIC.#(REQUIRED):ACKEREC084MA CITY OF EVERETT BUSINESS LIC.#(REQUIRED):27335 PRIMARY CONTACT: ❑OWN ER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:380-336-61 88 EVAN A CONTACT EMAIL:ACKERECO@FIDALGO.NET AGREEMENT:I hereby certify that/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 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 2-1-19 E tJ/I t`!" Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application