3003 W CASINO RD BLDG 40-58 2021-02-22

ECTRICAL PERMIT APPLI ION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps©everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3003 West Casino Road Everett, WA 98204 BUILDING AREA: 1" 6'IJ U sq ft PROJECT TYPE: ✓❑ NEW CONSTRUCTION ✓❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION.INFORMATION 8►:DESCRIPTION OF WORK... CONTRACT PRICE OF WORK:$ 43Oe O Z OC' ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 1 module circuit joint venture with Veca Electric THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑✓ YES-Select Scope: ✓❑ Service ✓❑ Feeder ❑✓ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio El Secure Access ❑ 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: ✓❑ NO ❑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: ENO EYES-See Below& Pg. 3 I 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 ,kt OWNER NAME: Boeing TENANT BUSINESS NAME(If Commercial): Boeing OWNER MAILING ADDRESS: STREET 3003 West Casino Road c,n Everett STATE WA Z,p 98204 OWNER PHONE: OWNER EMAIL: r CONTRACTOR NAME: Re awk Fire & Secu • CONTRACTOR ADDRESS: sr 12 30TH DR SE Bo ll STATE WA ZIP 98021 CONTRACTOR PHONE:42 75-4545 NTRACTOR EMAIL:michelleburkhart@adt.com CONTRACTOR LIC.#(RE IRED):REDHAHF882NH CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 45269 PRIMARY CONTACT: DOWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: + CONTACT PHONE:425-375-4545 Michelle Burkhart CONTACT EMAIL:michelleburkhart@adt.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 I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: al E)b ri4 03-20-2020 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application