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,,r`ECTRICAL PERMIT APPL....ATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> ., 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8010 1 FAX 425-257-8857 I(E_)everetteps@everehWa.gOV 1 vww.everettwa•gov/permits
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<br /> PROJECT ADDRESS: 1427 S 100th St Everett Wa 98027 BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑TENANT IMPRO\/HENT ❑ REMODEL
<br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE El DUPLEX ❑ ADU Cl MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> ELECTRiCIAL!A'PPLfllfs"'AlTIDN"iINE5'!OR11 AT.iON &',:';DESCRIPIITIONI,:f F,WORK P; I. .!rll t
<br /> CONTRACT PRICE OF WORK:$ 25000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> replacing all existing security devices with new and adding three new cameras to the site
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-4; ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices;15
<br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat Cl Audio ❑ Secure Access ❑✓ Security System
<br /> ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system. An additional
<br /> Fire Alarm Permit Is required for review of device location and Installation approval.
<br /> ❑ Other(List All):
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<br /> iS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO • YES--See Below&Pg. 2
<br /> n 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
<br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review,
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: MNO EYES-See Below&Pg.3
<br /> Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent, sale,or lease
<br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that i have completed and
<br /> see page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
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<br /> OWNER NAME: Fairway Estates TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 4616 25th ave ne Ste 701
<br /> CITY Seattle STATE Wa zip 98105
<br /> OWNER PHONE:206-567-7787 IOWNER EMAIL:fairway@fcpmw.com
<br /> CONTRACTOR NAME: Guardian Security Systems
<br /> CONTRACTOR ADDRESS: STREET1743 1st ave so
<br /> CITY Seattle STATE Wa zip 98134
<br /> CONTRACTOR PHONE:206-622-65455 'CONTRACTOR EMAIL:mgere@guardiansecurity.com
<br /> CONTRACTOR LIC.
<br /> µ RDSS233K5
<br /> ., (CITY OF EVERETT BUSINESS LIC.#(REQUIRED):033443
<br /> #(R�OWNER ._,_ ,�
<br /> PRIMARY CONTACT: ❑✓CONTRAC TOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-467-5262
<br /> Mary Gere CONTACT EMAIL:mgere@guardiansecurlty-com
<br /> AGREEMENT:I hereby certify that I have read and oxominod this application end know the same to be true and corroo, All provisions of lows and ordinances governing this
<br /> type of work will be c. •ted whether specified horoin or not. The granting of a permit does not prosutno fo give authority to violate or cancel the provisions cf any other F1,ato or
<br /> beet low rogulatin ons ction or the performance of construction, That/am authorized by the owner of this properly to porlorm the work for which application is made end I
<br /> comply with the "lair• al,9pfors i,ow 18,27 RCW and 290200 1/;/AC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> 3T11/2019 E n03 " C( 5
<br /> Owner)Aut i Agent Signature Date f�oviSod
<br /> � 1/11/2019) Page 1-Application
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