1715 BROADWAY 2020-01-21 - Laserfiche WebLink

ELECTRICAL PERMIT & FIRE ALARM rtRMIT APPLICATION �., CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 ( FAX 425-257-8857 1 (E)everetteps a@everettwa.gov( www.everettwa.gov/permits PROJECT SITE INFORMATION ,PROJECT ADDRESS: 1715 BROADWAY, EVERE I I , WA 98201 PROJECT TYPE: ❑INEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE ❑ UPLEX ❑CDU 0,V1ULTI-FAMILY-#OF UNITS- U1 COMMERCIAL BUILDING AREA: 35,000 sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 5000.00 ASSOCIATED BUILDING PERMIT#(if applicable., IS THIS LOW VOLTAGE WORK? 0 NO QI YES-#OF DEVICES: 20 IS THIS A FIRE ALARM PERMIT? 1NO 0 YES-Hans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Camera install. Wire is ran by different company_ THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 11.1 I By checking this box, I am stating that I have read and understand all of WAC 295-46B-900,selected the specific reason on page 2 Ea 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: 101 Pursuant to RCW 199.28.261, 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 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1715 BROADWAY :.'Tr Everett STATE WA ZIP 98201 OWNER PHONE: 4252529898 OWNER EMAIL; CONTRACTOR NAME: Northwest Low Voltage INC CONTRACTOR ADDRESS: STREET 17026 SE 326th Place carr Auburn STATE WAz:, 98092 CONTRACTOR PHONE: 253-279-9770 CONTRACTOR EMAIL: nwlowvoltage@corncast.net CONTRACTOR LIC.#(REQUIRED): NORTHLV954B5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 59927 PRIMARY CONTACT: EI OWNER 1. CONTRACTOR El OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-279-9770 Tom Mellor CONTACT EMAIL: nwlowvoltage@comcast.net comcast.net 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 authonzed by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 1&.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# - -'' f 9 - 0s2_ Offer uthorized Agent Signature Date (Revised 10/30/2014) Page 1 of 3