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

AIL* 11/ ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET.EVERETT, NA 98201 WAsH8FiG (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa gcv www everettwa.govipennts ToN PROJECT SITE INFORMATION' PROJECT ADDRESS: 840 N Broadway - LI BUILDING AREA: 2500 sq ft ti111. PROJECT TYPE: NEW CONSTRUCTION 0 ADDITIO .... TENANT IMPROVMENT El REMODEL BUILDING USE: Li SFR 0 TOWNHOUSE Ell DUPLEX Ell ADU El MULTI-FAMILY #OF UNITS RI COMMERCIAL Etticiftts4L APPISIOA.TION INFORMATION &DESCAIFIRRiorwoRK II CONTRACT PRICE OF WORK:$ 13,500.00 ASSOCIATED BUILDING PERMIT#(if applicable); DESCRIBE SCOPE OF WORK: Low Voltage Cabling THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 0 YES-Select Scope El Service El Feeder El Circuits-#. E.,]Complete Re-wire LOW VOLTAGE WORK? CI NO 0 YES-#of Devices:45 SELECT SCOPE(REQUIRED). El Data 0 Intercom 0 Thermostat El Audio El Secure Access CI 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. 0 Other)List Ali): CODE COMPLIANCE - IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 0 YES --See Below&Pg.2 By cnecking this box. I am stating that I have read and understand ail 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: 17:INO 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. . .0.01141TACT INFORMATi , OWNER NAME: TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sressy CITY SATE Z P OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Evergreen Technologies Inc CONTRACTOR ADDRESS: STREET 3623 E Marginal Way S Seattle STATE WA 7,, 98134 CONTRACTOR PHONE:206-774-1363 CONTRACTOR EMAIL:mcan@evergreentec.com CONTRACTOR LIC.#(REOUIRED):EVERGTI929K9 CITY OF EVERETT BUSINESS LAC.#(REOUIRED): 050182 . - PRIMARY CONTACT: 001A1NER CONTRACTOR ['OTHER(Please Specify) tritwaevergreentec.com CONTACT NAME: CONTACT PHONE:206-774-1363 Meryem Can CONTACT EMAIL: 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 wont will he 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 o, local law regulating construction or the performance of construction That am authorized by the owner of this property to perform the work for which apprication is made and comply wit State Contract rs Law 18 27 ROW and 295.200 WAC City of Everett Official Use Orly PERMIT#. /1129 E Vc\CI - c)3 \ Owner/ ized t Signatur Date / (Revised 1/11/2019) Page I-Application