6521 EVERGREEN WAY 2020-02-07 - Laserfiche WebLink

1610 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa,gov I w,m,everettwa gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6521 Evergreen Way Everett, WA 98203 BUILDING AREA: 2200 sq ft PROJECT TYPE: LI NEW CONSTRUCTION Li ADDITION Li TENANT IMPROVMENT RI REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX LI ADU LI MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Swapping of 16 Low voltage voice/data cables under 24 volts for the front registers, credit card readers and Kitchen monitors THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO E YES-Select Scope: [1] Service 11:1 Feeder E Circuits-#: E Complete Re-wire LOW VOLTAGE WORK? El NO YES-#of Devices: 16 SELECT SCOPE(REQUIRED) El Data El Intercom D Thermostat ID Audio El Secure Access El Security System Li 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: RI NO D YES--See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-46B-S00,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: 7NO EYES-See Below&Pg. 3 Pursuant to RCW 19.28 261, property owners and leaseholders cannot perform electrical work on buildings f ITs^aior lease without the proper electrical licensing and certification,or exemption.By checking this box, I am statin have comAted and See page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this l!censlngl9éfllficatlon requirement CONTACT INFORMATION 1130 r ,a:n7a OWNER NAME: Dairy Queen TENANT BUSINESS NAME(If Commercial): Dairy Queen OWNER MAILING ADDRESS: SlREEI 6521 EVERGREEN WAY EVERETT STATE WQ zip 98203 OWNER PHONE: OWNER EMAIL: - CONTRACTOR NAME: Jafed Boer CONTRACTOR ADDRESS: STREET 16001 West 99th St. citY Lenexa STATE KS z' 66219 CONTRACTOR PHONE:913-227-3924 CONTRACTOR EMAIL:permits@wachtercorn CONTRACTOR LIC.#(REQUIRED):EC WACHTI"904KL CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 043582 PRIMARY CONTACT: DOWNER IZICONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:913-227-3924 Jared Botteron CONTACT EMAIL:permits@wachter.com AGREEMENT' 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 few regulating construction or the performance of construction, That I am authorized by the owner of this properly to perform the work for which application is made and I comply with tie State Contractors Law 18.27 RCVV and 296.200 WAC. City of Everett Official Use Only PERMIT#: Air ,e— V, ;9 c - 23 Owner/At ..'oriied •6---- igtiaturF Date (Revised 1/11/2019) Page 1-Application