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ENO <br /> Li ELECTRICAL PERMIT APPLICATION <br /> I <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 1200cEDARsTREET,EVERETT,WA 98201 <br /> I <br /> WASH I N(VON (P)425-257-8810 I FAX 425-257-81557 I(E)everetiepS(§evetettwa gov I www•everettwa govipermits I <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2.911 California Avenue BUILDING AREA: 12445 sq ft <br /> . <br /> PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-1 OF UNITS: CZ]COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 9,914 ASSOCIATED BUILDING PERMIT*(if applicable): noci-00 <br /> DESCRIBE SCOPE OF WORK: <br /> Installation of(32) Cat6 voice/data low voltage cables. , <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOP,I ,1-ECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO 0 YES-Select S4 p:: 111 -ervice 0 Feeder .0 Circuits-#: 0 Complete Re-wire, <br /> LOW VOLTAGEWORK? 0 NO [Z]YES-#of Devi -s:32 <br /> _ r..., <br /> SELECT SCOPE(REQUIRED): GZI Data 0 Intercom • Ther 'stet 1J Audio 0 Secure Access 0 security System <br /> 0 Fire Alarm-Installations un.- . permit only include electricall,viring 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 All): <br /> CODE COMPLIANCE VIA- <br /> ...... __ 1 <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH AND/OR PERSONAL CARE FACILITIES: 1'4 tJ leint See Below&Pg.2 <br /> ElBy checking this box,.I am stating that I have read and understand all of WAC 296-46B-94,, : ected the specific reason on page 2 <br /> of this application(see next page),AND Plan Review is NOT required because I m-. all of the following sub sections that do not <br /> See Page 2 requite Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: !ZINO OYES-See Below&Pg.3 <br /> Pursuant to RCW 1928.261,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 <br /> -CONTACT INFORMATION <br /> - <br /> OWNER NAME: Everett Public Schools; TENANT BUSINESS NAME(If Commercial): ' LSS Ar?--CA, <br /> OWNER MAILING ADDRESS: STREET 3900 Broadway 2(VE LieA ' — <br /> Everett STATE WA zip 982 1 <br /> OWNER PHONE: jOVVNEFt EMAIL: <br /> CONTRACTOR NAME: Structured Communications <br /> CONTRACTOR ADDRESS:, STREET PO Box 1368 <br /> , <br /> CITY Snohomish -STATE WA ZIP 98291 <br /> CONTRACTOR PHoNE:425-321-5343 ooNTRAoTOR EMAIL.;dustirldUke@gcstructured.cOITI <br /> CONTRACTOR LIC,0 REOUIRED STRUCC*8920L CITY OF EVERETT BUSINESS UC REQUIRED-050586 <br /> PRIMARY CONTACT; DOWNER (ZICONTRACTOR 00THER(Please Specify) <br /> CONTACT NAME: , . CONTACT PHONE:425-367-3977 <br /> David Meyer CONTACT EMAIL:davicirneyer@gostructured.com I <br /> A RE v -, . -1 ce ' a have rea.and examined this erp• cat• and know the same,to be true and correct An pmviS•ns of lam. •ord emits governing this <br /> type 0 f work Will be completed whether specified herein or not The granting of a permit does not presume to give authonfy to violate or canoe the provisions O4' <br /> lad ! <br /> other state or <br /> loud law regulating construction or the performance of construction. That lam authorized by the owner of this property to perfOnn the war*for which application is made and I <br /> comply with the Stater Contractors Law 16-27RCW and 296.200 WAC. City of Everett Official use Only <br /> PERMIT#: <br /> y41 <br /> Aii 4 <br /> tAigritsr / , / eei . E \ 'Uk_— <br /> (--, <br /> ] <br /> ks ,....,.. <br /> * zed Agient - '-rirTT" Date (Revised 1/11,...._ <br /> Page 1-ApplIcation <br /> --,- <br />