840 N BROADWAY B 2021-07-12 - Laserfiche WebLink

1111: ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASH CiTON (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwagov I wwweverettwagov/permits IN PROJECT SITE INFORMATION PROJECT ADDRESS: 840 N Broadway Bldg A 2nd Floor BUILDING AREA: 3360 sq ft PROJECT TYPE: E NEW CONSTRUCTION Ell ADDITION 0 TENANT IMPROVMENT [-I REMODEL BUILDING USE: El SFR El JOWNHOTSE DUPLEX [1::]ADU E] MULTI-FAMILY-#OF UNITS: IAL ELEPHTIAL APPuCAJrIoN INFORMATION & DESCRIPTION ORK CONTRACT PRICE OF W912K:$ 19,000.00 ASSOCIATED BUILDING PERMIT#(if app b e): DESCRIBE SCOPE OPIWORK: Demo existing ele tncal, ad ceptacles, relocate lighting, installing new lighth,1-44we4ing—SWitching to accommodate new ice layout. Replacing existing exit signs, and installing new exit signs. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? LI NO E]YES-Select Scope: Ei Service C] Feeder El Circults-#:6LI Complete Re-wire LOW VOLTAGE WORK? [7] NO El YES-#of Devices. SELECT SCOPE(REQUIRED) E Data El Intercom El Thermostat El Audio El Secure Access El Security System El 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, El Other(List All). CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 171 NO El YES--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 29646B-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: 7NO 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: TENANT BUSINESS NAME(If Commercial): Department of CSO OWNER MAILING ADDRESS: sTrst, 840 N Broadway Building A 2nd Floor Everett STATE WA 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pro-Tech Electric, Inc CONTRACTOR ADDRESS: STREET 1126 Bonneville Ave vry Snohomish STATE WA zp 98290 CONTRACTOR PHONE:425.334.9844 CONTRACTOR EMAIL:Tbentem@pro-techelectric.com CONTRACTOR LIC.#(REQUIRED):PROTETE934JC CITY OF EVERETT BUSINESS LIC.#(REOUIRED): 055041 PRIMARY CONTACT: EOVVNER CONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.334.9844 Taylor- Office CONTACT EMAIL:Tbentem@pro-techelectric.com AGREEMENT I hereby certify that I have read and examined this application and knitw 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 properly to perform the work for Which application is made and comply with the State Contractors Law 18,27 PCW and 296,200 WAC City of Everett Official Use Only PERMIT#' , E 9 (DR. 2j4 Owner/Authorized Agent Signature Date (Revised 1111/2019) Page 1-Application