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E _ECTRICAL PERMIT APPLIUTION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov( wAw.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 3003 WEST CASINO ROAD I 100K BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ©TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ (tQ lASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> REPLACE OBSOLETE TYCO MONITORING PANEL
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑Service El Feeder ❑Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO Q YES-#of Devices:47
<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 /> El Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Lij NO I YES--See Below&Pg.2
<br /> ❑ By checking this box,I am staling 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: ONO DYES-See Below&Pg.3
<br /> I 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.
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<br /> OWNER NAME: BOEING TENANT BUSINESS NAME(If Commercial): 40-56 bldg. Col. BB-2
<br /> OWNER MAILING ADDRESS: STREET 3003 WEST CASINO ROAD 45-01 BLDG. COL K-4
<br /> CITY EVERETT STATE WA ZIP 98203
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: ALEXANDER GOW FIRE EQUIPMENT CO.
<br /> CONTRACTOR ADDRESS: STREET 1436 NW 53RD STREET
<br /> CITY SEATTLE STATE WA ZIP 98107
<br /> CONTRACTOR PHONE:206-632-2810 CONTRACTOR EMAIL:kmullen@gowfire.com
<br /> CONTRACTOR LIC.#(REQUIRED) ALEXAGF097NW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 050029
<br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-718-1009
<br /> KEV I N M U L L E N ,CONTACT EMAIL:kmullen@gowfire.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 /> //-2 E 5
<br /> w er/Authorized Agent Signature Date (Revised 1/1172019) Page 1-Application
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