3211 BROADWAY AMERICAN INSURE ALL 2020-01-21

E CTRICAL PERMIT APPLI ,TION CITY OF EVERETT PERMIT SERVICED 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3211 BROADWAY AVE, Suite A BUILDING AREA: 1,500 sq ft PROJECT TYPE: _ NEW CONSTRUCTION ❑ ADDITION N TENANT IMPROVMENT ❑ REMODEL BUILDING USE: H SFR ❑ TOWNHOUSE ❑ DUPLEX HI ADU ❑ MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 367 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Connecting Illuminated Channel Letters and Contoured logo sign to existing 20 amp dedicated circuit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO n YES-Select Scope: ❑ Service ❑ Feeder n Circuits-#: I- Complete Re-wire LOW VOLTAGE WORK? n NO YES-#of Devices: 2 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System ❑ 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): Channel Letter Signs mounted on a raceway 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓ NO TYES-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: MARK REICH LIN TENANT BUSINESS NAME (If Commercial): American Insure-All OWNER MAILING ADDRESS: STREET 1806 MARINE DR NE CITY MARYSVILLE STATE WA ZIP 98271 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Skyline Electrical Services LLC CONTRACTOR ADDRESS: STREET 26516 12TJ DR NW CITY Stanwood STATE WA ZIP 98292 CONTRACTOR PHONE:425.626.3679 CONTRACTOR EMAIL:alex@skylineelectric.com CONTRACTOR LIC.#(REQUIRED):EC SKYLIES82ORD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 60163 PRIMARY CONTACT: HOWNER ✓CONTRACTOR ]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.626.3679 Alex Moody CONTACT EMAIL:alex@skylineelectric.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#: -/*2.6/, ECS \ OwnerlAuthoried Agent Signature Date (Revised 1/11/2019) Page 1-Application