1715 BROADWAY 2020-01-21 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 _ (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits 4f.'67-7- PROJECT SITE INFORMATION PROJECT ADDRESS: 1715 Broadway Everett, WA 98201 PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION Q TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0,MULTI-FAMILY-#OF UNITS: I;21 COMMERCIAL BUILDING AREA: 33,600 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 6,000. ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO lel YES-#OF DEVICES: 12 Cat6 Date IS THIS A FIRE ALARM PERMIT? 0 NO YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Installation of(12) Cat6 Data Cables for Security Camera locations THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ErBy 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. ATTENTION OWNERS: THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ri 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 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 Stores Inc#474 TENANT BUSINESS NAME(If Commercial): Safeway OWNER MAILING ADDRESS: STREET 1371 Oakland Blvd #200 CITY Walnut Creek STATE CA ZIP 94596 OWNER PHONE: (623)8694384 OWNER EMAIL: CONTRACTOR NAME: Pacific Communications Cabling CONTRACTOR ADDRESS: STREETT 10604 E Riverside Dr. �/�// CITY Bothell STATE y yA ZIP 9801 1 CONTRACTOR PHONE: (425)483-5957 CONTRACTOR EMAIL: administrator@pacificcc.com CONTRACTOR LIC.#(REQUIRED): PACIFCC910L5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 035656 PRIMARY CONTACT: TEOVVNER q CONTRACTORra OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (425)422-3240 Garry Mumm CONTACT EMAIL: 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# 04X 4-1,kki 3/ 15119 \Ct 0 — 1-4 Owner/Authorized Agent Signature Date (Revised 10/30/2018)