410 SW EVERETT MALL WAY 2020-03-06

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET.EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa gov I wwevorettwa.gov/permits • PROJECT SITE INFORMATION PROJECT ADDRESS: 410 sw Everett mall way BUILDING AREA: 2500 sq ft PROJECT TYPE: 0 NEW CONSTRUCTION LI ADDITION El TENANT IMPROVMENT LI REMODEL BUILDING USE: D SFR D TOWNHOUSE El DUPLEX C.ADU El MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 795 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: emergency fire panel replacement. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO D YES-Select Scope: D Service El Feeder D Circuits-#: D Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices:'t SELECT SCOPE(REQUIRED): D Data E] Intercom E)Thermostat El Audio CD Secure Access El Security System 1:1 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: D 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: ENO OYES-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: Car toys TENANT BUSINESS NAME(If Commercial):car toys OWNER MAILING ADDRESS: STREET 410 sw Everett mall way ciry Everett STATE wa ,,,98204 OWNER PHONE:425-356-2726 OWNER EMAIL: CONTRACTOR NAME: White Security Systems CONTRACTOR ADDRESS: STREET12617 108th ave he Arlington STATE wa 98223 CONTRACTOR PHONE:425-402-0366 CONTRACTOR EMAIL:WSSl@Whitesecurity,corn CONTRACTOR LIC.#(REcuisED):campbn*872or CITY OF EVERETT BUSINESS LIC,#(REQUIRED):37276 PRIMARY CONTACT: DOWNER OCONTRACTOR ClOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-402-0366 heather CONTACT EMAIL:WSSI@Whitesecurity.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true end 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 lam authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Heather Foster 05/15/2019 E kck05 - Owner/Authortzed Agent Signature Date (Revised 1/1140193' Page 1-Application