6200 23RD DR W TEAGUE 2020-08-28

INN 111.1 ELECTRICAL PERMIT APPLielTION 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 wvvw.everettwa.gov/permits PROJECT SITE1NFORMAT$ON ::'., PROJECT ADDRESS: 6200 23rd Drive W BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 12000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Relocate (1) 125A 208V Panel, Install (1) new 100A 208V Panel, Install (6) new 15A 120V four-plex receptacles, Install (3) new 30A 208V twist lock receptacles - Job #59884 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 0 YES-Select Scope: ❑ Service El Feeder 0 Circuits-#:5 ❑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 COMPLi4 NCE g IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓Q 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: TENANT BUSINESS NAME(If Commercial):Teague OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pride Electric, Inc. CONTRACTOR ADDRESS: STREET18133 NE 68th St, D-120 CITY Redmond STATE WA 98052 CONTRACTOR PHONE:4254543665 CONTRACTOR EMAIL:mbender@prideelectric.com CONTRACTOR LIC.#(REQUIRED):PRIDEEI077DR CITY OF EVERETT BUSINESS LIC.#(REQUIRED):027137 PRIMARY CONTACT: ❑OWNER EICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4254543665 Matt Bender CONTACT EMAIL:mbender©prideelectric.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#:. S ' 7/f E 1 (-1U " 011 0 ner/Authori ed Agent Signature Date (Revised 1/11/2019) Page 1-Application