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PIP ELECTRICAL PERMIT APPLICATION <br /> �' <br /> CITY OF EVERETT PERMIT SERVICES <br /> �''�' 1> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa gay I www.everettwa.govtpermits <br /> SITE INFORMATION <br /> PROJECT ADDRESS: 6133 Lake Chaplain Rd. BUILDING AREA N/A sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: El SFR El TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: Q COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION VF-.WORK <br /> CONTRACT PRICE OF WORK:$ $26,500.00 ASSOCIATED BUILDING PERMIT#(if applicable): N/A <br /> DESCRIBE SCOPE OF WORK: <br /> Re-wire MCC for 600KW Generator. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑NO 21 YES-Select Scope:El Service ® Feeder ❑Circuits-# ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ®NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access El Security System <br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval <br /> 0 Other(List Ail): <br /> x , ... 'CODE COMPLIANCE <br /> D/ . ..'.. . . <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO El YES—See Below&Pg.2 <br /> a 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. EYES ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES See Below&Pg.3 <br /> ❑ <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. It <br /> ,CONTACT INFORMATION <br /> OWNER NAME: Mike Robinson TENANT BUSINESS NAME(If Commercial):COE-Water Filtration Plant <br /> OWNER MAILING ADDRESS: STREET 6133 Lake Chaplain Rd. <br /> crn, Monroe STATE WA N,98272 <br /> OWNER PHONE:(425) 257-8203 OWNER EMAIL:mrobinson@everettwa.gov <br /> CONTRACTOR NAME: Seahurst Electric <br /> CONTRACTOR ADDRESS: STREET2915 Chestnut St. <br /> cny Everett STATE WA z>, 98201 <br /> CONTRACTOR PHONE:(425) 258-1882 CONTRACTOR EMAIL:reception@seahurst.com <br /> CONTRACTOR LIC.#(REQUIRED):SEAHUEIOO99QN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425) 258-5143 <br /> Dave LeBlanc CONTACT EMAIL:dleblanc©sehurst.com <br /> AGREEMENT:I hereby certify that 1 have read end examined this epplicatron and know the same to be true and caned. Alt provisions of laws end ordinances govormng this <br /> 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 <br /> focal 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 t <br /> comply with the Slate Contractors Law 18.27 RCW end 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: _) <br /> 3-5-19 E )01D �-b — <br /> OwnerfAuthoriz Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />