7621 BEVERLY LN 2021-07-12 - Laserfiche WebLink

MN •ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov I www everettwa gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: Evergreen MS - 7621 Beverly Ln, Everett, WirsIBUILDING AREA: 9G0 sq ft PROJECT TYPE: El NEW CONSTRUCTION I❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL �1 BUILDING USE: ❑ SFR El TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: �r 1 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 60.000 'ASSOCIATED BUILDING PERMIT#(if applicable). To Be Determined DESCRIBE SCOPE OF WORK: Addition of single classroom portable building to existing middle school electrical distribution. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO C YES-Select Scope: ❑ Service 0 Feeder ❑Circuits-#:i ❑Complete Re-wire LOW VOLTAGE WORK? El NO ©YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom ❑ Thermostat El Audio El Secure Access ❑✓ Security System 0 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 U 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. CONTACT INFORMATION OWNER NAME: Everett Public Schools TENANT BUSINESS NAME(If Commercial): Evergreen Middle School OWNER MAILING ADDRESS: STREET 3900 Broadway CITY Everett Si,TF WA _P 98201 OWNER PHONE:425-391-6251 (OWNER EMAIL:Jcollins@everettsd.org CONTRACTOR NAME: TBD-Public Bid CONTRACTOR ADDRESS: STREET' CITY n �P CONTRACTOR PHONE: 'CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR LOTHER(Please Specify) E'en''"'E'y'°ee` CONTACT NAME: CONTACT PHONE:206-459-0763 Jeff Hoover, PE-Hargis Engineer CONTACT EMAIL:jeff.hoover@hargis.biz 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 D 444.A....2, PERMIT#: EW04-0F1 Owner/Authorized Ag t(ynature ` (Date/ (Revised 1/11/2019) Page 1-Application