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LLECTRICAL PERMIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps a@everettwa.gov I voww.everettwa.gov/permits
<br /> PROJECT ADDRESS: 1 101 Industry St BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT J❑ REMODEL
<br /> BUILDING USE: SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: Q COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 7,000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBES OPE OF WORK:
<br /> Install 34 at6 Circuits (at workstations)
<br /> Install 2 view 24 port patch panels in server room with wire management system
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑Service ❑ F der ❑Circuits-#: E Complete Re-wire
<br /> LOW VOLTAGE WORK? NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): Data ❑ Intercom D Thermostat udio ❑Secure Access ❑ Security System
<br /> ❑ Fire Alarm-Installations und'e-rihWernily 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 L YES--See Below&Pg.2
<br /> nBy checking this box, I am stating that I have read and understand all of WAC 296-4613-900,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: ENO EYES-See Below&Pg.3
<br /> Pursuant to RCW 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: Jeremy Hall TENANT BUSINESS NAME(If Commercial):Western Pacific
<br /> OWNER MAILING ADDRESS: STREET 1101 Industry St
<br /> CITYEVERETT `r, Z,P 98203
<br /> STATE V VA
<br /> OWNER PHONE: (503) 572-2224 OWNER EMAIL: J.hall@gowestpac.com
<br /> CONTRACTOR NAME: PARKER BROS ELECTRIC
<br /> CONTRACTOR ADDRESS: STREET 13630 54TH DR NE
<br /> clTv MARYSVILLE STATE WA ziN 98271
<br /> CONTRACTOR PHONE:425-239-6319 CONTRACTOR EMAIL: gary@parkerbroselectric.com
<br /> CONTRACTOR LIC.#REQUIRED PARKEBE( ) 845NT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):56709
<br /> PRIMARY CONTACT: ❑OWNER ❑CO,...., .,,,,.,,, ,,.... ,.., ... ,,..., ..... .. ......,, .,<r... .,.. .«,... .
<br /> NTRACTOR ❑OTHER{Please Specify) OFFICE ADMIN w r
<br /> CONTACT NAME: CONTACT PHONE:360-572-0108
<br /> Natalie CONTACT EMAIL: admin@parkerbroselectric.corn
<br /> 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
<br /> 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
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this properly to perform the work for which application is made and 1
<br /> comply with the State ntractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#:
<br /> kms/ 11/14/2019 E
<br /> Owner/Authorized,g nt Signature Date (Revised 1/11/2019)
<br /> Page 1•Application
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