1130 SE EVERETT MALL WAY SHARETEA 2020-02-06

IIS ICTRICAL PERMIT APPL: ATION EVERETT 32CITY OF EVERETT PERMIT SERVICt 00 C '-' ST`. T,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 E eretteps.teverettwa.gov I www.everettwa.gov/permits PROJ SITE IN7ORMATION PROJECT ADDRESS: 1 130 SE Everett Nall W,:y Suite# B ; BUILDING AREA: 1800 sq ft PROJECT TYPE: ❑NEW CONstkiicT)ON ❑ ADDI 'eN E2 .. NANt IMPROVP Nt ❑12EMODEL BUILDING USE: D SFR Q TOW,I\IHOUSE DUPLEX Il ADU ❑ MULTI-FAMILY-#OF UNITS: E COMMERCIAL ELECTRICAL"APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:'$ 500 ASSOCIATED'BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Sign Existing Power & J - BOX & TIMER Connection THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑ YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(,REOU1, D): ❑ Data ❑intercom ❑Thermostat ❑Audio ❑ Secure Access 17I 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):Sign connection CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO El 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 requited 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 stati , ave a pleted and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensi 0- : '.n require -nt. CONTACT INFORMATION ,7 OWNER.NAME: TENANT BUSINESS.NAME(If Com ercial): Shere Tea OWNER MAILING ADDRESS: STREET S �� CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: NW ELECTRIC SERVICES INC CONTRACTOR ADDRESS: STREET324193rd Ave SW CITY Federal Way STATE WA zip 98023 • CONTRACTOR PHONE:253 561 5861 CONTRACTOR EMAIL:kimeUntae56@gmail.COm CONTRACTOR LIC.#(REQUIRED):NWELEES925DL CITY OF EVERETT BUSINESS LIC.#(REQUIRE► : PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) t CONTACT NAME: CONTACT PHONE:253 561 5861 (/�r, e u n to e kim CONTACT EMAIL:ki-hieljr'vtaeS8ggiliall.ciiri v L 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 la -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 comp) with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only 'i3EiNiiT#: /0 _07 _ ads E �� k o ~ COR Own'.r/Authorized Agent Signature Date / (Revised 1/11/2019) Page 1-Application