7909 EVERGREEN WAY MOD PIZZA 2021-01-28

• • ELECTRICAL PERMIT APPLICATION V R E T T 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHIN©TON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps,teverettwa.govl wvw.everettwargov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7909 Evergreen Way Everett '78Lc3 BUILDING AREA:3274 sq ft PROJECT TYPE: E NEW CONSTRUCTION ❑ADDITION E TENANT IMPROVMENT El REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE El DUPLEX ❑ADU MULTI-FAMILY-#OF UNITS: E COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 20k ASSOCIATED BUILDING PERMIT#(If applicable): DESCRIBE SCOPE OF WORK: renovation for an existing building to faciltate a new MOD pizza THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) +1 -' LINE VOLTAGE WORK? 0 NO E✓ YES-Select Scope:E Service El Feeder ❑Circults-#:t ❑Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ❑Flre 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO I YES—See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-468.900,selected the specific reason en 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:ENO DYES-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. Al CONTACT INFORMATION ,v;.,aize, ....• :: OWNER NAME: MOD Pizza TENANT BUSINESS NAME(If Commercial):Mod Pizza OWNER MAILING ADDRESS: STREET 7909 Evergreen Way Everett ' cm( Everett STATE�'va 7.I' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: System Solutions of Washington CONTRACTOR ADDRESS: STREET P.O. box 5308 CITY Lynnwood STATE Wa zip 98046 CONTRACTOR PHONE:425-249-2076 JCONTRACTOR EMAIL: FredW@SystemSolutionswa.com CONTRACTOR LIC.#(REQUIRED):Systesw900PD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ECONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-391-4905 Fred Wirtz CONTACT EMAIL:FredwQ(,,,}Sys#emsolulianswa.com 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 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 local law regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: (Z611 Owne uthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application