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EVERETT <br />WASH INGTON <br />OECTRICAL PERMIT APPLWTION <br />CITY OF EVERETT PERMIT SERVICE <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: 1622 East Marine View Dr'BLDG E <br />BUILDING AREA: 44,764 sq ft <br />PROJECT TYPE: 0 NEW CONSTRUCTION ❑ ADDITION TENANT IMPROVMENT ❑ REMODEL <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU 0 MULTI -FAMILY - # OF UNITS:32 ❑ COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK: $ 625,700.00 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: <br />Data Comm. CCTV and fire rough in only <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ✓❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire <br />LOW VOLTAGE WORK? ❑ NO ✓❑ YES- # of Devices: 328 <br />SELECT SCOPE (REQUIRED): ✓❑ Data ❑ 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): CCTV (1 camera) <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: LVI NO LJ 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 />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: ❑✓ NO DYES -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: Riverview LLC TENANT BUSINESS NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 10900 NE 8th St Suite 1200 <br />CITY Bellevue STATE WA ziP 98004 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: Applied Business Communications <br />CONTRACTOR ADDRESS: STREET 13029 NE 126th PL <br />, Kirkland STATE WA ZP 98034 <br />CONTRACTOR PHONE:844-662-2266 <br />CONTRACTOR EMAIL: eCaSper@p abcomllc.COn1 <br />CONTRACTOR LIC. #(REQUIRED):APPLIBC843CS <br />ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 052069 <br />PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER (Please Specify) <br />CONTACT NAME: <br />Eric Casper <br />CONTACT PHONE:206-236-9979 <br />CONTACT EMAIL:eCaSper@abCOmIIC.Com <br />AuKLcmcty i : / nereny centry that i nave 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/ <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br />Owner/Authorized Agent Signature <br />PERMIT #: <br />E 161 I Z- 01'1 <br />Date (Revised 1/1112019) Page 1-Application <br />