6220 EVERGREEN WAY VALUE VILLAGE 2020-02-07

ECTRICAL PERMIT APPL ATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6220 Evergreen Way _ (BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION LI ADDITION L✓J TENANT IMPROVMENT ❑ REMODEL BUILDING USE: C SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORKp ASS CONTRACT PRICE OF WORK: $ $3000 OCIATED BUILDING PERMIT#(if applicable): p\ O\O'03g DESCRIBE SCOPE OF WORK: Disconnect roof unit and reconnect new roof unit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder Circuits-#:2 ❑ 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. E. Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 7 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: ONO 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 OWNER NAME: TENANT BUSINESS NAME (If Commercial):Value Village OWNER MAILING ADDRESS: STREET 6220 Evergreen Way CITY Everett STATE WA Zlp 98203 OWNER PHONE:4253558820 OWNER EMAIL: CONTRACTOR NAME: Beach Electric CONTRACTOR ADDRESS: STREET PO Box 17462 CITY Seattle STATE WA ZIP 98127 CONTRACTOR PHONE:206784555i CONTRACTOR EMAIL:mlke@beaCheleCtriC.US CONTRACTOR LIC.#(REQUIRED):BEACHEL960Jv CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ; PRIMARY CONTACT: ]OWNERCONTRACTOR [OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:20631031 97 Dennis Ferleman CONTACT EMAIL:mike@beachelectric.us 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 loc. law re•ulatin•construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I com. ate Contractors -1-8. RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: C 2 t, E in- b2) Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application