11031 19TH AVE SE 2019-10-01 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 j FAX 425-257-8857 1 (E)everetteps@everettwa.gov l www.everettwa.gov/permits 4Err PROJECT SITE INFORMATION PROJECT ADDRESS: 11031 19TH AVE S E, EVERETT, WA 98208 PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION O TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS, L.,i3 COMMERCIAL BUILDING AREA: 35000 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$4000 ASSOCIATED BUILDING PERMIT#Of applicable): IS THIS LOW VOLTAGE WORK? 0 NO c1 YES-#OF DEVICES: 21 IS THIS A FIRE ALARM PERMIT? ❑NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Install CCTV cameras. Wire has already been pulled by a different company. THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: [alBy checking this box, I am stating that I have read and understand all of WAC 296-468-900,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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: laPursuant 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 seating that I have completed and signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Safeway TENANT BUSINESS NAME(If Commercial): Safeway OWNER MAILING ADDRESS: STREET 11031 19TH AVE S.E. cm EVERETT STATE WA zie 98208 • OWNER PHONE: 425-337-0886 OWNER EMAIL: CONTRACTOR NAME: Northwest Low Voltage, INC. CONTRACTOR ADDRESS: STREET 17026 SE 326th Place QTY Auburn STATS WA <,r, 98092 CONTRACTOR PHONE: 253-279-9770 CONTRACTOR EMAIL: nwlowvoltage@Comcast.net CONTRACTOR LIC.#(REQUIRED): NORTHLV554135 CITY OF EVERETT BUSINESS LIC.#(REGUIR[D): 59927 PRIMARY CONTACT: ca OWNER JO CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-279-9770 Tom Mellor CONTACT EMAIL: nwlowvoltage@comcast.net AGREEMENT I hereby certify that 1 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 ate 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# //---7- /S ' _AS — C05 OwneriK' orized Agent Signature Date (Revised 10/30/2018) —