6101 ASSOCIATED BLVD SAFEOLOGY 2022-01-19

• 0 ELECTRICAL PERMIT APPLICATION EVERETT WASHINGTON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6101 Associated Blvd #101 IBUILDING AREA: sq ft PROJECT TYPE: ❑✓ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 100 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: install one wall sign THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System ❑ 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: 0 NO D YES -- See Below & Pg. 2 ❑ 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 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: ❑NO DYES -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: Safeology TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET 6101 Associated Blvd #101 C,Ty Everett STATE WA Z,, 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Berry Sign Systems CONTRACTOR ADDRESS: STREET7400 Hardeson Rd CITY Everett STATE WA ZIP 98203 CONTRACTOR PHONE:4257768835 1CONTRACTOR EMAIL:tracies@berrysignsystems.com CONTRACTOR LIC. #(REQUIRED):berryss857b7 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 024786 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Trade Skiles CONTACT PHONE:4257768835 X 114 CONTACT EMAIL:tracies@berrysignsystems.com �1—tv 1. 1 nt—my cenny ulai ! nave reau anu examined this appucauon ano Know me same to oe 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 coin ith the State Contractors Law 18.27 RCW and 2962 WAC. City of Everett Official Use Only PERMIT #: �( E ZM`� -COS Ow r/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application