11731 AIRPORT RD LA PALMERA RESTAURANT 2019-10-30

ELECTRICAL PERMIT APPL ATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SATE INFORMATION PROJECT ADDRESS: 11731 Airport Rd BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Final Connections for(3)LED illuminated "La Palmera Family Mexican Restaurant & Lounge Wall Signs and (1) LED Green boarder on wall. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO El YES-Select Scope: El Service El Feeder ❑Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat ❑Audio El Secure Access El 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): Sign Circuts/border outline M',j ts an, IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO El 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: ❑✓NO 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: BRIDGE33 PROPERTIES I LLC TENANT BUSINESS NAME(If Commercial):LA PALMERA OWNER MAILING ADDRESS: STREET 4001 S DECATUR BLVD SUITE 6, en, Las Vegas STATE NV ZIP 89103 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Heath Northwest CONTRACTOR ADDRESS: STREET 727 South 96th St CRY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE:206-623-3100 CONTRACTOR EMAIL:crystals@heathnOrthwest.cOm CONTRACTOR LIC.#(REQUIRED): HEATHNI981JZ CITY OF EVERETT BUSINESS UC.#(REQUIRED):04-1617 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-623-3100 Crystal Canter CONTACT EMAIL:crystals@heathnorthwest.com 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 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#: /' 414 11°1 E tqoc$p Owner/Authorized Agent z Date (Revised 1/11/2019) Page 1-Application