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

Immo ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT WA 98201 , (P)425-257 8810 FAX 425-257-8857 (E)everettebs@everettwa goy wWW evereilwa govlbermns PROJECT SITfc INFORMATION PROJECT ADDRESS: 840 N Broadway 1),)-- BUILDING AREA: 2500 soft PROJECT TYPE: U NEW CONSTRUCTION 0 ADDITION _ TENANT IMPROVMENT LI REMODEL BUILDING USE: ri SFR 0 TOWNHOUSE El DUPLEX U ADU 0 MULTI-FAMILY #OF UNITS COMMERCIAL E/40TRICAL.AFPLWATION't TION: D*SCRIPTIQN 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? 0 NO El YES-Select Scope Ei Service E Feeder 0 Circuits-#. El Complete Re-wire LOW VOLTAGE WORK? El NO 0 YES-#of Devices:45 SELECT SCOPE(REQUIRED). 0 Data El Intercom 0 Thermostat 0 Audio El Secure Access LI 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. [2]Other(List AO CODE rtal4PLJANCIE . . IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO El 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, WNW, ONTACT INFORMATION : - ' -"" OWNER NAME: TENANT BUSINESS NAME(If Commercial): \ - r OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL, CONTRACTOR NAME: Evergreen Technologies Inc CONTRACTOR ADDRESS: STREET 3623 E Marginal Way S CITY Seattle STATE WA 7., 98134 CONTRACTOR PHONE:206-774-1363 CONTRACTOR EMAIL:mcan©evergreentec.conn CONTRACTOR LIC.#(REQUIRED):EVERQT1929k9 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 050182 PRIMARY CONTACT: DOWNER WICONTRACTOR [JOTHER(Please Specify) rocanaevergreentec cum 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 Ali provisions of taws and ordinances governing this Type of work will be completed whether speeded 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 That I am authorized by the owner of this property to palter,the work for which application is made and comply wit State Contrac rs Law/8 27 RCW and 2915.200 WAC City of Everett Official Use Only PERivIIT le1.29 / E Owner' ized t Signatur Date if (Revised 1/11/2019) Page i-Apptication