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

ELECTRICAL LRMIT & FIRE ALARM PLI-IMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:11031 19th Ave.SE Everett,WA 98208 PROJECT TYPE: 0 NEW CONSTRUCTION D ADDITION 0 TENANT IMPROVMENT U REMODEL BUILDING USE: 0 SER 0 TOWNHOUSE D DUPLEX 0 ADU DI MULTI-FAMILY- #OF UNITS: 0 COMMERCIAL BUILDING AREA; Safeway sq ft 10,000 ELECTRI '64'1 PLICATION INFORMATION CONTRACT PRICE OF WORK:$15,000 ASSOCIATED BUILDING PERMIT#(if applicable). IS THIS LOW VOLTAGE WORK? El NO LI YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? El NO 0 YES- Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Retrofit IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO El YES--See Below&Pg,2 ElBy 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:ONO OYES-See Below&Pg. 3 Pursuant to ROW 19.28 261,property owners and leaseholders cannel 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 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: s f nEET 1 1031 19th Ave. SE Everett STATE WA 98208 OWNER PHONE: 'OWNER EMAIL: CONTRACTOR NAME:Timothy Paul CONTRACTOR ADDRESS: „,„i./17045 SE Royer Rd Damascus STATE OR 97089 CONTRACTOR PHONE:503-209-4006 ICONTRACTOR EMAIL:well_done_construction@yahoo.corn - CONTRACTOR LIC.#IIREOuRED):WELLDEC974D0 'CITY OF EVERETT BUSINESS LIC,#(Rl (hi I REr: 0M000000003219000000 PRIMARY CONTACT: DOWNER El CONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:503-209-4006 Timothy Paul CONTACT EMAIL:well_done_construction 0 yahoo.corn AGREEMENT;I hereby certify that/have ieed and examined this application and know the same to oe true and correct. Ali 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 298.200 WAC. City or Everett Offic!,z0 Use Only PERMIT# r? 1 C;t,CiA 01-10-2019 Owner/Authorized Agent Signature .7)/qe (Revised 11/612018) Page 1-Application