5209 EVERGREEN WAY GROCERY OUTLET 2020-05-08

ELECTRICAL P1 MIT & FIRE ALARM Phil. MIT APPLICATION CITY OF EVERETT PERMIT SER\kULS 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits 477- PROJECT SITE INFORMATION PROJECT ADDRESS:ta0C'\ al (&� �' % PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITIO 1I TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ ,S©O ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? S NO ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 1Zi NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: \ Th ¶*C-. \\Cj'(\ ) "'Is N4C -.\1 \NC IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: J,iO 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, elected 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 DYES-See Below&Pg. 3 I I Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildi 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: MV) E C3\L CCS '(L \C?v-, CONTRACTOR ADDRESS: STREET Q� (,I I \v CITY '�\}'C STATE ` ZIA O 1 CONTRACTOR PHONE: CONTRACTOR EMAIL: \Ce 6) C\ C 1,"�c . c CONTRACTOR LIC.#(REQUIRED): II CONTRACTOR 1 \J �� k\kAy CITY OF EVERETT BUSINESS UC.#(REQUIRED):CZc1 b PRIMARY CONTACT: ❑OWNER U./ ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:t5-) 2Uk1/4\CA\ 0 — CC.1 4\0\\ \ C CONTACT EMAIL: � 'C�r�`i j V, \ ,,OC -CQM AGREEMENT:I hereby certify t at 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 I am authorized by the owner of this property to perform the work fowhich 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# 2� lg 'Q Ig/A — t 0 Owner/A h riz ent Signature D�te (Revised 11/5/2018) Page 1-Application