15 SW EVERETT MALL WAY MARINER FINANCE 2020-02-07

E k_ECTRICAL PERMIT APPL ATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: j 31„,) �� CJv BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION NfTENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: IN COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 59 ASSOCIATED BUILDING j.PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 'c yl,, aor1.I�Q -Inn ( /� L61J 111 oin fo4zf o Vt (t e.2e,i- on �l t � ,O,- tanCL THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.Art additional Fire Alarm Permit is required for review of device location and installation approval. ❑Other(List All): CODE COMPLY , IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: I� 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:g(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 �J OWNER NAME: •tf`3\ `),�1� Yom►"Ajs�.Le, TENANT BUSINESS NAME(If Commercial): Ft amet, OWNER MAILING ADDRESS: STREET ?O toer R! Q CRY � V STATE INA ZIP 1�boo cr OWNER PHONE:`'L aaq' 2230 OWNER EMAIL: CONTRACTOR NAME: 1.4- 4T ( M OP.- CONTRACTOR ADDRESS: STREET g} JJ { ( cr, ,S)P a4 Ce., STATE ' ZIP CONTRACTOR PHONE:2,C1P 3100 CONTRACTOR EMAIL: � "m COPS, CONTRACTOR LIC.#(REQUIRED): a UT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): L_S( ( PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME• CONTACT PHONE: 6 0 "1 -771 c u ea Y,12 1 CONTACT EMAIL: cc Q (' AGREE :I hereby certify that I have read and examined this application and know the sa e o be true an.correct. All provisions of laws and ordinances governing 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.erf. ..-, -. construction. That I am m authorized by the owner of this property to perform the work for which application is made and I comply with the State Con - aw 18.27 RCW and 29..'10 WAC. City of Everett Official Use Only PERMIT#: 4114111 zic.4 E V3\o ... )(1 \ Ignature Date (Revised 1/11/2019) Page 1-Application