729 100TH ST SE WA STATE LABOR AND INDUSTRIES 2020-01-23

mom L ELECTRICAL PERMIT APPLIPTION E CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 wnstiiNcTory (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits ',131ROJECirlirrE INFORMATION PROJECT ADDRESS: 729 100th St. SE. Everett, WA. 98208 BUILDING AREA: 1500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION: NFORMATIO 4 A,RERCRIPTION'OF'WORK CONTRACT PRICE OF WORK: $ 1,250.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: INSTALL 2 NETWORK CONNECTION TO FRONT COUNTER THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select S, o,•:-._1 Service Cl Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of:oe ices: 2 ) SELECT SCOPE(REQUIRED): Data CI Interc'm ❑Ther, stat ❑Audio ❑ Secure Access El Security System ❑ Fire Alarm-Installation r •er 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 COMPLIANDE771,, IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: A 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 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. CONTACT INFORMATION OWNER NAME: Johnson Family LMT Partners TENANT BUSINESS NAME(If Commercial):Dept of Labor and Industries OWNER MAILING ADDRESS: STREET PO Box 5253 ciT- Everett STATE WA. ZIP 98206 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CTS CONTRACTOR ADDRESS: STREET 2720 S. Ash St. cn-y Tacoma STATE WA ZIP 98409 CONTRACTOR PHONE: (206) 686-2000 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CTS**TS881BK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 048173 PRIMARY CONTACT: EOWNER ®CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (360) 951-8124 John Horger CONTACT EMAIL: JohnH@cableCTS.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#: Ekl/titcy Tact/tar 10/4/2019 E OL- Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application