2128 BROADWAY J AND J TIRES 2022-01-24

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: 2128 Broadway- Everett, WA 98201 IBUILDING AREA: 100 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: $ 550 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Install Cellular Monitoring unit on existing Fire Alarm System. 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: 1 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: W1 NO YES -- See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46113-900, 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: ONO ❑YES -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: DAT Property Investments TENANT BUSINESS NAME (If Commercial): J & J Tires OWNER MAILING ADDRESS: STREET 21903 43RD CT W ,T, MOUNTLAKE TERRACE STATE WA Z,P 98043 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Klepps, Inc. CONTRACTOR ADDRESS: STREET 13330 SE 30th Street c,TY Bellevue STATE WA ZIP 98005 CONTRACTOR PHONE: 425-223-3164 CONTRACTOR EMAIL: Phil@klepps.com CONTRACTOR LIC. #(REQUIRED): KLEPPI'938C6 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 51351 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Phil Bo n ste i n CONTACT PHONE: 425-591-2850 CONTACT EMAIL: phil@klepps.com tium=mm v i. i nereay cerury rnar i nave reap ana exammea tnis appucaaon ana Know me same to oe true and correct..vu provisions or laws ana orainances governing tins 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/ am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: /6 L17 E� Owner/Aut#orized Agent Signature Date (Revised 111112019) Page 1-Application