6200 12TH DR SE 2020-01-22 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 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 HFORMAT OP4 PROJECT ADDRESS: 6107 Berkshire Drive BUILDING AREA: 10000 sq ft PROJECT TYPE: ❑✓ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL EHEC TION TIOKIREOJRWRTVKAOtRtRIFTION OF WORK CONTRACT PRICE OF WORK: $ 18,600 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Low Voltage Class 2 HVAC Wiring THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? LINO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:50 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom 0 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): PuAN E 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: ONO 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. OWNER NAME: TENANT BUSINESS NAME(If Commercial): Everett Safe Street OWNER MAILING ADDRESS: STREET 6107 Berkshire Drive c,,,, Everett STATE Wa zip 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Static Energy CONTRACTOR ADDRESS: sTREET17600 105th AVE SE CITY Snohomish STATE wa ZIP 98296 CONTRACTOR PHONE:206-718-8481 CONTRACTOR EMAIL:tOddkahlt@StatiCenergyinC.COm CONTRACTOR LIC.#(REQUIRED):STATIE1872OZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):053253 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-71 8-8481 Todd Khall CONTACT EMAIL:toddkahl@staticenergyinc.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#: Todd Khali 5/30/19 F Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application