3214 BROADWAY BROADWAY KINECT APARTMENTS 2021-08-11

• w ELECTRICAL PERMIT APY I OC ATOON 11‘,--di CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits PROJECT SITE INFORMATION.: PROJECT ADDRESS: 3Zi . �l J + (S COC G ►`tcA��C< (BUILDING AREA: sq ft PROJECT TYPE: EW CONSTRUCTION 0 aDDITIGIN ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ®FR ❑TOW USE 0 1 UPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRIC APPLICAT,•N-INFORMATION &:DESCRIPTION.OF WORK CONTRACT PRICE OF WORK:$ 0 t O 'ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK1 /0C) A / 0 d )scD n n�c_'11 •- - (( () av \ 0. Ot� , s THIS INSTALLATION INCLUDES THE FOLLO NG SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO YES-Select Scope: ❑ Service 0 Feeder 0 Circuits-#: - 0 Complete Re-wire LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom 0 Thermostat 0 Audio 0 Secure Access 0 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 COMPLIANCE: IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO 0 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 OYES-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 . tt . )1`-11TANT BUSINESS NAME(If Commercial):AYYh'tca1? /'n 73a1F--'�y OWNER NAME:�)'br7[�tc,rcif a �e{�►te�n'�• OWNER MAILING ADDRESS: 7/](STREET //O Ave.;e.. /Lie._ `tt 5-5-0 / i /J� cm, 7 J I eOU1€ C STATE c�rf ZIP f J`/U41 OWNER PHONE: 4-1Z`5"1°9- 12- L 'OWNER EMAIL: CONTRACTOR NAME: Si i /i) p/`I e_ - • 1 S ` CONTRACTOR ADDRESS: 355'ID s�REE ��T / (C.; ' / C— it-)6_ p Q CITY�I t n_ lI-STATE 1Art- ZIP / S��-- " '� 7 - "f CONTRACTOR EMAIL: LLC AU A-Irt ce.,;-ouck C+vl)-e. 1 CONTRACTOR PHONE:`7Z� S G ��lc�L �T CONTRACTOR LIC.#(REQUIRED):Snic ke_PEc!33 M-g ICITY OF EVERETT BUSINESS LIC.#(REQUIRED • PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR `OTHER(Please Specify) f'f, 1 Ct� CONTACT NAME: CONTACT PHONE: L)z 75 0—346- -" c ^ \, 1 ' k`,( 0 CONTACT EMAIL:chari YY1Gt{k Y)s. SINi� pe)tvi1 9 l l C •t P-slJ� AGREEMENT:I hereby certify that!have read and examined this application and know the same to be true and correct. All p©visio laws and the ordinances of governingothe this hste or type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to or f provisions local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work r for Ewhrett Ohich pic lica ati ion Use made e and! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. CitPERMIT#: Ce/r4)).1.%, .-I� 3 4,_,6 (1 9 E \90 -- ` Ecg 1-Application Owner/Authorized Agent Signatu - !� Date (Revised 1/11/2019) Page