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ELECTRICAL 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: 607 Riverside Road 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:$ 184,000 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Electrical components installation of conveyor systems. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data El 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):Conveyor System Instali:tion <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. J <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO YES 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: Panatonni Development TENANT BUSINESS NAME(If Commercial): Amazon <br /> OWNER MAILING ADDRESS: STREET 20411 SW Birch Street, Suite 200 <br /> CITY Newport Beach STATE CA ZIP 92660 <br /> OWNER PHONE:949.474.7830 OWNER EMAIL:info@panatonni.com <br /> CONTRACTOR NAME: Darana Hybrid, Inc. <br /> CONTRACTOR ADDRESS: STREET345 High Street, 5th Floor <br /> CITY Hamilton STATE Ohio ZIP 45011 <br /> CONTRACTOR PHONE:513-785-7540 CONTRACTOR EMAIL:darana@daranahybrid.com ' /_O 1 <br /> CONTRACTOR LIC.#(REQUIRED):DARANHI892QS (CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (� 61 <br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:716.572.8969 <br /> Darryl Cuttell CONTACT EMAIL:darana©daranahybrid.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 /> PERMIT#: <br /> 0061,64/9ail7' q E \� 0 � � 2 \ <br /> Owner/Authorid Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />