3003 W CASINO RD BLDG 40-421 2020-04-01

! CTRICAL PERMIT APPLIATION �� CITY OF EVERETT PERMIT SERVICES - 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 3003 West Casino Road,Everett,WA 98203 Building 40-421 2,K-P BUILDING AREA:Building 40-421 2,K-P sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY #OF UNITS: ❑X COMMERCIAL CONTRACT PRICE OF WORK:$ $3,500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 219304-Removing and replacing(1)receptacle,remove and relocate(1)receptacle. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑X YES-Select Scope:❑Service ❑Feeder 0 Circuits-#: 2 ❑ Complete Re-wire LOW VOLTAGE WORK? 0 NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat El Audio El Secure Access El 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO I 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: ©NO AYES-See Below&Pg.3 71Pursuant 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. OWNER NAME: Boeing Company TENANT BUSINESS NAME If Commercial : OWNER MAILING ADDRESS: STREET PO Box 3707 MS 1 F 09 CITY Seattle STATE WA ZIP 98124 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Foy Group CONTRACTOR ADDRESS: STREET 901 Powell Ave SW Suite 100 CITY Renton STATE WA zip 98057 CONTRACTOR PHONE: 206.937.6150 CONTRACTOR EMAIL: cory.s@foygroup.net CONTRACTOR LIC.#(REQUIRED): FOYGRGC863LK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044569 PRIMARY CONTACT: CI OWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Cory Simpson CONTACT PHONE: 425.283.9515 CONTACT EMAIL: cory.s@foygroup.net 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 lam 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#: 1/912020 E .soo ` — o5 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application