2722 COLBY AVE SNO CO PUBLIC DEFENDER 2019-11-01

Rem iri LCTRICAL PERMIT APPLI TION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2722 Colby #200 BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT El REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1,200.00 ASSOCIATED BUILDING PERMIT#(if applicable): B1907-017 DESCRIBE SCOPE OF WORK: Extend 3 existing circuits into new offices for desk power in Sno Co Public Defenders Association office THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope:❑Service ❑ Feeder Cl Circuits-#:3 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom El 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑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. EI NO YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: UNO ❑YES-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: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Dahl Electric, Inc. CONTRACTOR ADDRESS: STREET3409 McDougall Ave CITY Everett STATE WA ZAP 98201 CONTRACTOR PHONE:4255-252-1 700 CONTRACTOR EMAIL:dstevens@dahlelectric.com CONTRACTOR LIC.#(REQUIRED):DAHLEEI926QD CITY OF EVERETT BUSINESS LIC.#(REQUIRED):037-024 PRIMARY CONTACT: DOWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: AlCONTACT PHONE:425-346-5317 Jeff A �SO n CONTACT EMAIL:jdallison7@msn.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 l am authorized by the owner of this property to perform the work for which application is made and f comply with the State Contractors L w 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PipPERMIT#: �, l �1 E � q Off' 1, 10 9 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application