332 SW EVERETT MALL WAY NATIONAL GENERAL INSURANCE 2020-02-07

E CTRICAL PERMIT APPLI4 TION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 OterrFAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 332 SW Everett Mall Way, 98204 BUILDING AREA: sq ft PROJECT TYPE: H NEW CONSTRUCTION ADDITION ✓ TENANT IMPROVMENT —I REMODEL BUILDING USE: H SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL 01 ELECTRICAL APPLICATIOWINFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 836.00 ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIBE SCOPE OF WORK: 1901417 17175 - Install outlet for TV in 3rd floor break room 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? ❑ 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): �.' 3 �� _ gee IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: Li 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 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: ❑✓ 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. 7:: OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Titan Electric CONTRACTOR ADDRESS: STREET 12828 Northup Way Suite 205 CITY Bellevue STATE WA ZIP 98005 CONTRACTOR PHONE:206.633.2811 CONTRACTOR EMAIL:Permits@titanelectric.net CONTRACTOR LIC.#(REQUIRED):TITANEI96308 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51191 PRIMARY CONTACT: DOWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206.633.2811 Jon Osborn CONTACT EMAIL:permits@titanelectric.net AGREEMENT.t 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 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 State Contractors Law 18.27 R W and 296.200 WAC. City of Everett Official Use Only PERMITER #: 6ti/J 6/5/2019 ` Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application