1125 80TH ST SW 2020-02-25 - Laserfiche WebLink

iiiiiiiiiii■ ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1125 80th ST SW BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 14,100 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Retrofit office troffers with 2x4 LED kits, retrofit T8 fluorescent lights with LED tubes, add occupancy sensors to Offices, restrooms and lunchroom. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 17 YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom El Thermostat El Audio El Secure Access ❑ Security System El 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: 71 NO ❑YES--See Below&Pg.2 nI I 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: ENO 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): Nelson Petroleum OWNER MAILING ADDRESS: STREET 1125 80th ST SW CITY STATE STATE WA ZIP 98203 OWNER PHONE:(425) 353-9701 OWNER EMAIL:koryd@nelsonpetroleum.com (service manager) CONTRACTOR NAME: Rex Electric Service CONTRACTOR ADDRESS: STREET 11112 18th ST NE CITY Lake Stevens STATE WA ZIP 98258 CONTRACTOR PHONE:425-422-1744 CONTRACTOR EMAIL:rriecks@gmail.com CONTRACTOR LIC.#(REQUIRED):REXELES962N4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):48749 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-422-1744 Robin R i ecks CONTACT EMAIL:425-422-1744 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 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 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ,>6 ,Pao.. 2-4-20 E 2 V 02- O Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application