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NEN <br /> ELECTRICAL PERMIT APPLICA ON <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3003 W. Casino Rd. Bldg 40-37 door E16 column CIOUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 7775 ASSOCIATED BUILDING PERMIT#(if applicable): NA <br /> DESCRIBE SCOPE OF WORK: <br /> Install 30-amp feeder and a 120-volt transformer and panel for a vertical material lift <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service 0 Feeder ❑✓ Circuits-#:2 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <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: ✓❑NO DYES-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: Boeing Company TENANT BUSINESS NAME(If Commercial): Boeing Company <br /> OWNER MAILING ADDRESS: STREET 3003 West Casino Road <br /> CITY Everett STATE WA ZIP 98204 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Innovative Electric, Inc. <br /> CONTRACTOR ADDRESS: STREETP.O. Box 4399 <br /> c„v Everett STATE WA ZIP 98204 <br /> CONTRACTOR PHONE:425-290-7803 CONTRACTOR EMAIL:gunnar @innovative-electric.com <br /> CONTRACTOR LIC.#(REQUIRED):INNOVE1055KE CITY OF EVERETT BUSINESS LIC.#(REQUIRED):36828 <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-571-3947 cell <br /> Gunnar CONTACT EMAIL:gunnar@innovative-electric.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 ith the State Contractors La and 296.200 WAC. City of Everett Official Use Only <br /> e PERMIT#: <br /> nnar Petzold 08/01/19 <br /> E \c'to , <br /> Owner/Authorized Agent ure Date (Revised 1/11/2019) Page 1-Application <br />