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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> vi 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT ADDRESS: 1220 75th St. SW Everett , WA 98203 BUILDING AREA: sq ft
<br /> PROJECT TYPE: ✓❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
<br /> attigAMMELEVERICAPARIRUCAIMMIVIORa
<br /> CONTRACT PRICE OF WORK:$ 150 ASSOCIATED BUILDING PERMIT#(If applicable): S1812-007
<br /> DESCRIBE SCOPE OF WORK:
<br /> Install new wall sign and connect to customer provided existing circuit.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑NO 0 YES-Select Scope:0 Service El Feeder ❑Circuits-#: ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): ❑Data Cl Intercom El Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> ❑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 /> El Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓�NO u 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: ENO OYES-See Below&Pg.3
<br /> ❑ 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.
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<br /> OWNER NAME: Tim Koetje TENANT BUSINESS NAME(If Commercial):Axiom Construction&Consulting
<br /> OWNER MAILING ADDRESS: STREET 1220 75th St. SW �}
<br /> CITY Everett STATE WA ZIP 98203
<br /> OWNER PHONE: 360-354-1184 X 218 OWNER EMAIL:tim@axiomcc.net
<br /> CONTRACTOR NAME: SIGNS PLUS INC. fi
<br /> CONTRACTOR ADDRESS: STREET766 Marine Dr.
<br /> CITY Bellingham STATE WA zii'98225
<br /> CONTRACTOR PHONE:(360) 671-7165 CONTRACTOR EMAIL:sales@Signsplusnw.COm
<br /> CONTRACTOR LIC.#(REQUIRED):EC SIGNSPI954LW CITY OF EVERETT BUSINESS LIC,#(REQUIRED):052728
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<br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR EOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:(360) 671-7165
<br /> Cruz Allen CONTACT EMAIL:cruz@signsplusnw.com
<br /> 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
<br /> type of work will be com.Ieted 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
<br /> local law regulating c, •ruction or the performance of construction, That I em authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the S -e ontractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> •
<br /> /z 2/i 9 E 61,- 11-6
<br /> • er/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
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