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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-2:)",,8­16 1 FAX 425-257-8857 1 (E) everett-aps@everattw,4.gov I www.everet,wa.gov/permits <br />PROJECT ADDRESS: 9930 Evergreen Way Bldg. A IBUILDING AREA: 14,805 sqft <br />PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION A TENANT IMPROVMENT 0 REMODEL <br />BUILDING USE: F] SFR [I TOWNHOUSE F-1 DUPLEX 0 ADU 0 MULTI -FAMILY - # OF UNITS. COMMERCIAL <br />CONTRACT PRICE OF WORK:$ 69,720.36 1ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: Provide a full and cornl2lete Electric -al aystem that includes lighting, lighting conLrols, and <br />general purpose r ceptades for new spaces and remodel of existing. <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ❑ NO YES - Select Scope- Ll Service F.1 Feeder X Circuits-#: Complete Re -wire <br />LOW VOLTAGE WORK? NO ❑ YES- # of Devices: <br />SELECT SCOPE (REQUIRED): F-1 Data El intercom [I Thermostat [I Audio [I Secure Access ❑ Security System <br />El Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional <br />Fire Alarm Permit is required for review of device location and installation approval. <br />Other (List All): <br />'PECOMPLIIAN <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: F-7_- �YES — See Below & Pg. 2 <br />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 <br />of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: EINO [7YES -See Below & Pg. 3 <br />El Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br />See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br />T I'VE <br />OWNER NAME: Therapcutic I lealtli Services TENANT BUSINESS NAME If Commercial): <br />OWNER MAILING ADDRESS: sTREET 9930 Evergreen Way <br />,rTy Everett STATEWA zip 98204 <br />OWNER PHONE: 1OWNER EMAIL: <br />CONTRACTOR NAME: B"view Electric <br />CONTRACTOR ADDRESS: STREET 11777 Water Tank Rd. Suite A <br />crry Burliiig-r gton s-,A EWA zip 98233 <br />CONTRACTOR PHONE: 360-707 0-935 <br />ICONTRACTOR EMAIL: Jenniferd@bvelectric.net <br />CONTRACTOR LIC. #(REQUIRED): BAYV 1 Fj,9_-,j N K BUSINESS LIC. #(REQUIRED); <br />ICITY OF EVERETT <br />Iff'"17= I �11 <br />PRIMARY CONTACT: 17]OWNER NCONTRACTOR i1OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 360-707.0535 <br />Jennifer Dalton <br />CONTACT EMAIL: jeiiiiiferd@bvelectric.net <br />AurTae:N=tvv i nLreay cenny mar i nave read ana examineo rnfs appacavon ana Know me same ro ae Erue ano COMM. Atf PrOMOnS Ot taws ant? OfMnanCSS governing this <br />type of work wig be rornpieted whether specilled herein or not, The granting of a permit does not presurne to give authority to violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction That I am author*zed by the owner of this property to perform the work for which application is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 KIAC, City of Everett Official Use Only <br />IPERMIT <br />E %0'(11 D <br />Y%wnefAutharlzed Agent Signature Date (Revised 1/1112019) Page 1-Application <br />U <br />