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E ECTRICAL PERMIT APPL kTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASH,rNdTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1700 13TH STREET, EVERETT, WA 98201 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION H ADDITION " TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: L SFR ❑ TOWNHOUSE I DUPLEX ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 25,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> INSTALL A TOTAL OF (138) CAT6 PLENUM CABLES SPREAD ACROSS (60) TOTAL LOCATIONS. <br /> INSTALL SECURITY COMBO CABLE FOR (2) DOOR LOCATIONS AS WELL. PROJECT#51-4922 <br /> - <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? k NO ❑ YES-Select Scope: Li Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 1✓ YES-#of Devices:140 <br /> SELECT SCOPE (REQUIRED): ❑✓ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br /> ❑ Fire Alarm- Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑ Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑ YES-- See Below& Pg. 2 <br /> 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 <br /> of this application (see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES -See Below& Pg. 3 <br /> Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br /> without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: COCHRAN INC <br /> CONTRACTOR ADDRESS: STREET 12500 AURORA AVE N <br /> CITY SEATTLE STATE WAQIP 98133 <br /> CONTRACTOR PHONE:206-914-9493 CONTRACTOR EMAIL:NSKWARSKI@COCHRANINC.COM <br /> CONTRACTOR LIC.#(REQUIRED):000HRV088JS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19558 <br /> PRIMARY CONTACT: .DOWNER ✓CONTRACTOR EOTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONE:206-914-9493 <br /> DON STALTER CONTACT EMAIL:DSTALTER@COCHRANINC.COM <br /> 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 <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> F - Z / - i9 E <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />