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0 <br />A E�CTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I vAvw,everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2801 Oakes Ave. <br />1BUILDING AREA: sq it <br />PROJECT TYPE: -0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVIVENT El REMODEL <br />BUILDING USE: -0 SFR 0 TOWNHOUSE 0 DUPLEX Ll ADU -EIMULTI-FAMILY - # OF UNITS: COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK: $ 178,000.00 <br />1ASSOCIATED BUILDING PERMIT # (if applicable): B2001-004 <br />DESCRIBE SCOPE OF WORK: <br />Install branch circuits, new lighting, replace lighting, new controls, receptacles etc. Includes a new panel . <br />With a new 200A feeder. <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? _E1 NO _Z YES - Select Scope: _0 Service D Feeder _Z Circuits-#: 9 L] Complete Re -wire <br />LOW VOLTAGE WORK? 21 NO _E1 YES- # of Devices: <br />SELECT SCOPE (REQUIRED): 171 Data 0 Intercom 71 Thermostat J7 Audio Secure Access _Ej Security System <br />El 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 />J7 Other (List All): <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 0 11 YES -- See Below & Pg. 2 <br />By checking this box, I am stating that I have read and understand all of WAC 296-4613-900, selected the specific reason on page 2 <br />Fv_1 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:.7NO _F]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 I icen sing /certification requirement. <br />CONTACT INFORMATION <br />OWNER NAME: City of Everett TENANT BUSINESS NAME (if Commercial): Fire Department <br />OWNER MAILING ADDRESS: 111ET 2930 Wetmore Ave <br />My Everett sTATEWA ,,98201 <br />OWNER PHONE.- 425.257.6293 <br />'NER EMAIL: rsanchez@everettwa.gov <br />CONTRACTOR NAME: CLK CONSTRUCTION LLC <br />CONTRACTOR ADDRESS: STREIE Tl PO Box 885 <br />cr, Burlington STATEWA ZIP 98233 <br />CONTRACTOR PHONE. 360-389-2503 <br />ICON TRACTOR EMAIL: clkconstructionllc@msn.com <br />CONTRACTOR LIC. #(REQUIRED): CLKCOLK933DL ICITY <br />OF EVERETT BUSINESS LIC. #(REQUIRED): 45873 <br />PRIMARY CONTACT: EIOWNEP ZOONTRACTOR DOTHER (Please Specify) <br />CONTACT NAME: <br />Chris Kelley <br />CONTACT PHONE360-389-2503 <br />CONTACT EMAIL: clkconstructionllc@msn.com <br />AGREEMENT., I hereby certify that I have read and examined tills application arto Know the same to oe irue one curruct, mv pluvwvil� v faws aei u, j'"uW�VvV-11V — <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 ofconstructlon, 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 RCWand 296.200 WAC. — City of Everett Official Use Only <br />PERMIT #: I <br />08/03/2020 <br />OwnerfAuthorized Agent Signature Date (Revi Application <br />