11014 19TH AVE SE BASE FILE 2023-05-15

ELECTRICAL PERMIT APPLPATION Orerr 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.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1902 110th St SE, Everett, WA 98208 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: El SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ,, AELECTRICA :APPLICATION.I,NFORINIATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 8,000.00 ASSOCIATED BUILDING PERMIT#(if applicable) DESCRIBE SCOPE OF WORK: Replacement of damaged concrete light pole base. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑Service ❑ Feeder ❑✓ Circuits-#:1 ❑ Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access Cl 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 ❑ 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. z.; 'iu: mot;" I ? T„I NFORMAAT.ION OWNER NAME: Skotdal Real Estate TENANT BUSINESS NAME(If Commercial): 1`C j0\jr"_---/ OWNER MAILING ADDRESS: STREET 2707 Colby Avenue Suite 1200 cI, Everett STATE WA ZIP 98201 OWNER PHONE:425.252.5400 OWNER EMAIL:Dave.Graef@Skotdal.com CONTRACTOR NAME: Service Electric CONTRACTOR ADDRESS: STREET PO Box 1489 CITY Snohomish STATE WA ZIP 98291 CONTRACTOR PHONE:360.568.6966 CONTRACTOR EMAIL:sharon@secoinc.com CONTRACTOR LIC.#(REQUIRED):SERVIEC564Ru CITY OF EVERETT BUSINESS LIC.#(REQUIRED): oz9064 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206.419.1826 Andy Powers CONTACT EMAIL:andy.powers@secoinc.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#: 5‘ ` 3-2-2020 E ' co? —CJ‘,14 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application