8417 EVERGREEN WAY PANDA EXPRESS 2022-05-23

E CTRICAL PERMIT APPLII TION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 8417 Evergreen Way BUILDING AREA: TBD sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT L!I REMODEL BUILDING USE: LL SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ C ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Wire and install Class 2 CCTV system. Wire and install Intrusion alarm system. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) ' LINE VOLTAGE WORK? NO ❑ YES-Select Scope: ❑ Service ❑ Feeder Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:30 SELECT SCOPE(REQUIRED): E. 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):CCTV CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑ YES --See Below& Pg. 2 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 EYES-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 licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Panda Restaurant Group TENANT BUSINESS NAME (If Commercial): Panda Restaurant Group OWNER MAILING ADDRESS: STREET P.O. Box 1159 i' ,VI Le"il(i -a- CITY Rosemead STATE CA ZIP 91 770 OWNER PHONE:na OWNER EMAIL:https://www.pandarg.com/Contact-us CONTRACTOR NAME: Omni Security Technologies LLC CONTRACTOR ADDRESS: STREET32700 Pacific Highway South #14 CITY Federal Way STATE WA zip 98003 CONTRACTOR PHONE:253.391.4970 CONTRACTOR EMAIL:Info omnisecuritytech.COm CONTRACTOR LIC.#(REQUIRED):OMNISST835CS CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60560 PRIMARY CONTACT: HOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: Q Q r CONTACT PHONE:253.886.7781 Derek Palie1 CONTACT EMAIL:derek©omniSecurltytech.com J 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 I am authorized by the owner of this property to perform the work for which application is made and I comply with th-State Contrac i-w 18.27 RCW and 296.200 WAC. City of Everett Official Use Only a � it PERMIT#: 12.17.2019 E \0 \ 2 \' O '— ori i Agent Signature Date (Revised 1/11/2019) Page 1-Application