6727 EVERGREEN WAY BIG LOTS 2020-08-27

ELECTRICAL PERMIT APPLILATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PR•OJECr,SItE INFORMATION, ,. ..... ... . PROJECT ADDRESS: 6727 Evergreen Way BUILDING AREA: 35,000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICAL.aprociagowftwortmaroN a DESCRIPTION OF viroRK ,,,,h x ,` CONTRACT PRICE OF WORK:$ 5,400 ASSOCIATED BUILDING PERMIT#(if applicable):E`CVO —©23 DESCRIBE SCOPE OF WORK: Install Burg 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:49 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑ Security System El 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 AND/OR PERSONAL CARE FACILITIES: ✓❑ NO 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,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. 5j CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(If Commercial): Big Lots OWNER MAILING ADDRESS: STREET 6727 Evergreen Way ciTy Everett STATE WA zip 98203 OWNER PHONE: OWEMAIL: CONTRACTOR NAME: Simple Security "SeiMWas( y ' ' CONTRACTOR ADDRESS: STREET 23117 39th-Ave Se cITY Bothell STATE WA zip 98021 CONTRACTOR PHONE:425-806- CONTRACTOR EMAIL:officemgr@simplesecuritysolutions.com CONTRACTOR LIC.#(REQUIRE ):Simplss879RQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 54425 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: k CONTACT PHONE:425-766-8961 Shawn Noecker CONTACT EMAIL:officemgr@simplesecuritysolutions.com 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 the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: /( 1c 6/21/2019 E "ckO Co — "SIZ, Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application