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0 <br />MEN <br />em <br />EVERETT <br />WAP "IN (1-11 N <br />0 <br />ELECTRICAL 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 www,everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2801 Oakes Ave., Everett, WA 98201 <br />IBUILDING AREA: 8,800 -sq ft <br />PROJECT TYPE: El NEW CONSTRUCTION 11 ADDITION Z TENANT IMPROVMENT 0 REMODEL <br />BUILDING USE: 0 SFR D TOWNHOO$E [I DUPLEx EIADU 11 MULTI. -FAMILY -#OF UNITS: COMMERCIAL <br />ELECT�PAL AP!JICATION INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK:,$ - 3,000.00 1ASSOCIATED BUILDING PERMIT # (if applicable): B2001-004 <br />DESCRIBE SCOPE OF WORK: <br />City Electricians to pull artdipstall voice and data low voltage cable for city owned building. <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? NO F] YES - Select 22!Lp�ervjce 0 Feeder D Circuits-ti: Complete Re -wire <br />LOW VOLTAGE WORK? NO [21 YES-# of DeVces: 100 ) <br />SELECT SCOPE (REQUIRED): 7 Data 0 Intercom C] Thermostat Audio Secure Access Security System <br />D 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 />71 Other (List All): Voice <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO 71 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 />F-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 LICIENSURE: []NO OYES -Sea 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: City of Everett TENANT BUSINESS NAME (if Commercial)- Fire Department Administration <br />OWNER MAILING ADDRESS: STIIET 2930 Wetmore Ave <br />,,T, Everett sTArE WA ... 98201 <br />OWNER PHONE; 425.257,6293 <br />1OWNER EMAIL, rsanchez@everettwa.gov <br />CONTRACTOR NAME: Owner <br />CONTRACTOR ADDRESS: STRE1-.T,2930 Wetmore Ave <br />CITY Everett STATE WA 98201 <br />CONTRACTOR PHONE: <br />1CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): <br />TC ITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: ZOWNER DCONTRACTOR ZOTHER (Please Specify) Joe Merzlak/Scott Figgins <br />CONTACT NAME: <br />Ruben SanchezCONTACT <br />CONTACT PHONE: 425.257,6293 <br />EMAIL: rsanchez@everettwa.gov <br />AGHEEMENI: i hereby certify that I have read and examined! 1171s application and 1(now Ine same to ve true and correct 14tt provisions or taws ano aromances governing ulis <br />type of won< 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 ofany 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 INAC. Ci!x of Everett Official Use Only <br />PERMIT <br />'0wAer1AuthorIzedKge16t Signature.,1'. Date (Revised 1/11/2019) Page I -Application <br />