10210 EVERGREEN WAY 2020-03-06 - Laserfiche WebLink

ELECTRICAL PERMIT APPLR.,ATION 4rErrCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10210 Evergreen Way BUILDING AREA: 51400 sq ft PROJECT TYPE: El NEW CONSTRUCTION ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL .EC v. APPLIC ION I ,R IIATION A DESCRIP, • OF; F. CONTRACT PRICE OF WORK:$ 500.00 ASSOCIATED BUILDING PERMIT#(if applicable): B1811-010 DESCRIBE SCOPE OF WORK: Relocate two emergency lights (alter one circuit) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO E YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio El 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): CODE COMPLIANCE A r' 75itigfArnifatiiiNT IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 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: ❑✓ 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. CONTACT INFORMATION `<' r OWNER NAME: Everett Inns LLC TENANT BUSINESS NAME(If Commercial): Best Western OWNER MAILING ADDRESS: STREET 3500 188th St SW STE 121 c,n Lynnwood STATE WA zip 98037 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Datskiy Electric LLC CONTRACTOR ADDRESS: STREET 1908 Island View PL C,TY Anacortes STATE WA z,P 98221 CONTRACTOR PHONE:36O-941-4754 CONTRACTOR EMAIL:leo.d@datskiyelectric.com CONTRACTOR LIC.#(REQUIRED):DATSKEL820JT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Applied PRIMARY CONTACT: DOWNER DCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:3609414754 Leo S Datskiy CONTACT EMAIL:leo.d@datskiy@datskiyelectric.com AGREEMENT:I hereby certify that/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#: 1-29-19 Il — a Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application