9911 23RD AVE SE 2021-12-15 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) eve rettepsaeverettv✓a.gov I www,evereltvoa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 9911 23rd Ave SE I BUILDING AREA: scl ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: 91 COMMERCIAL ELECTRICAL APPLICATIONINFORMATION, & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: S 10M00 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPEOF WORK: perform 2 hour generator load bank test. disconnect building conductors, hook up to load bank. Perfom 2 hour load bank test. land and torque building conductors. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? © NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: El complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED). ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ 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 IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: ✓ NO F1 YES -- See Below & Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-466-900, 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 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓ NO DYES -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 kensinglcertification requirement. CONTACT INFORMATION OWNER NAME: Razz Construction TENANT BUSINESS NAME (If Commercial): Silverlake Resev©ir 3 OWNER MAILING ADDRESS: STaeeT 9911 23rd Ave SE ciTY Everett srA,_ WA zia 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Cummins Sales & Service CONTRACTOR ADDRESS: sTaeeT 1800 Fryar Ave cay Sumner STRTe DNA 98208 CONTRACTOR PHONE:425-235-3400 CONTRACTOR EMAIL: keith.maze@cummins.com CONTRACTOR LIC. #(REQUIRED): CUMMIIS53C4 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Rob Ekstrom ICONTACT CONTACT PHONE:206-786-6515 EMAIL: rob.r.ekstom@cummins.com ••�• .vrxr �V• Ir rant r'uovc tcaV n/fu Gn arlureeu 1RtJ �N}Irr�aifvn a/iL7 KRpW rRe Same tD tie rule anU LQrreL7. All provision$ 01 laws and ordinances governing this type of work roil/ be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the prorrsions of any other state or total lacy regulating construction or the performance of construction, That I am authorized by the owner of this property to perform the veoik for which application is made and t Comply I'Vith the State Contractors Latin 18 27RCWand 296,200WAC. City of Everett Official Use Only [PERMIT #: �- E M 02_ - OS 0 Owned kuthor ed Agent Signature Datef (Revised 1/11120191 Page 1-Application