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tECTRICAL PERMIT APPLICATION <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 West Casino Road Bldg 40-51 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑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:$ 1800 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> WIRE IN NEW ROLL UP DOOR OPERATOR IN BOEING BUILDING 40-51, DOOR BF-5 <br /> DECO Project#DD2002 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope: El Service El Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat El 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: ✓❑ 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 /> n 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: The Boeing Company TENANT BUSINESS NAME(If Commercial): The Boeing Company <br /> OWNER MAILING ADDRESS: STREET PO Box 3707 MS 1 F09 <br /> CITY Seattle STATE WA ZIP 98124 <br /> OWNER PHONE:(425)294-0514 OWNER EMAIL: <br /> CONTRACTOR NAME: Dutton Electric Company, Inc. <br /> CONTRACTOR ADDRESS: STREET 12407 Mukilteo Speedway Suite A-170 <br /> CITY Lynnwood STATE WA ZIP 98087 <br /> CONTRACTOR PHONE:425-347-7600 CONTRACTOR EMAIL:chaze@duttonelectric.com <br /> CONTRACTOR LIC.#(REQUIRED):DUTToec137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): o1sa11 <br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-599-5410 <br /> Peter N a uta CONTACT EMAIL:peter.n@duttonelectric.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 /> gNcs c4apa rcwm <br /> PERMIT#: <br /> Chaze Prayer <br /> E 200 2- I I1 <br /> R aa°n:I am pp ng ih a dowmeni / <br /> Oat 3020.02.1311:34'.53-0800 2/13/2020 <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />