228 SW EVERETT MALL WAY GOODWILL 2020-02-07

Els y az .ECTRICAL PERMIT APPATION ' CITY OF EVERETT PERMIT SERVI6E EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 228 SW Everett Mall Way BUILDING AREA: 24000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL A PLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 3,750 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install three exterior LED Iight5 along south exterior of the building for security illumination. a-, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 1 ❑ Complete Re-wire LOW VOLTAGE WORK? n 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.An additional Fire Alarm Permit is required for review of device location and installation approval. Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ 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: LINO DYES-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: Goodwill Industries TENANT BUSINESS NAME(If Commercial): Goodwill Industries OWNER MAILING ADDRESS: STREET 228 SW Everett Mall Way CITY Everett STATE WA z„, 98204 OWNER PHONE:425-353-0957 OWNER EMAIL: CONTRACTOR NAME: ZORKO ELECTRIC, INC. CONTRACTOR ADDRESS: STREET PO BOX 100 CITY DUVALL STATE WA ziP 98019 CONTRACTOR PHONE:425-788-7710 CONTRACTOR EMAIL:kentv@zorkoelectric.com CONTRACTOR LIC.#(REQUIRED):ZORK0E11210K CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 048520 PRIMARY CONTACT: OWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: Kent VanderWeide CONTACT PHONE:425-788-7710 CONTACT EMAIL:kentv@zorkoelectric.com AGREEMENT:I hereby certify that/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 ate Contr.ctors Law 18.27 CW and 296.200 WAC. City of Everett Official Use Only / / PERMIT#: 4/29/19 ''cAdcA --2___ 3 Owner/Authorized Agent Signature Date (Revised 1/11/2019) \ Page 1-Application