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3003 W CASINO RD BLDG 40-22 2020-11-24
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3003 W CASINO RD BLDG 40-22 2020-11-24
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Last modified
11/24/2020 11:40:16 AM
Creation date
11/24/2020 11:34:10 AM
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Address Document
Street Name
W CASINO RD
Street Number
3003
Tenant Name
BLDG 40-22
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II I <br /> ELECTRICAL PERMIT APPLICATION <br /> 4rErr CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION li "t <br /> PROJECT ADDRESS: 3003 West Casino Road, Everett,WA 98203 BUILDING AREA:Building 40-22 E9 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑X COMMERCIAL <br /> � 'RIC , PPLA *l. INFORMATION&.toeSCRIPTINOF WORK <br /> CONTRACT PRICE OF WORK:$ $5,500.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: 219162-Install two quadplex outlets. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑1 NO [YES-Select Scope: CI Service CI Feeder 7Circuits-#: 2 CI Complete Re-wire <br /> n I <br /> LOW VOLTAGE WORK? NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El 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: X❑ NO El YES--See Below&Pg. 2 <br /> x 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: ❑X NO EYES-See Below&Pg.3 <br /> X 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: Boeing Company TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 3707 MS 1 F 09 <br /> clm' Seattle STATE WA ZIP 98124 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Foy Group <br /> CONTRACTOR ADDRESS: STREET 901 Powell Ave SW Suite 100 <br /> CITY Renton STATE WA ZIP 98057 <br /> CONTRACTOR PHONE: 206.937.6150 CONTRACTOR EMAIL: cory.s@foygroup.net <br /> CONTRACTOR LIC.#(REQUIRED): FOYGRGC863LK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 044569 <br /> PRIMARY CONTACT: DOWNER X❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Cory Simpson CONTACT PHONE: 425.283.9515 <br /> CONTACT EMAIL: cory.s@foygroup.net <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 goveming 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 /> 6/27/2019 <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />
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