620 SE EVERETT MALL WAY GYRO HOUSE 2022-03-11

`I PECTRICAL PERMIT APPLI9RTION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425.257-8810 1 FAX 425-257-8857 1 (E) everetleps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 620 SE Everett Mall Way Suite # 400 Eve rettd BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ✓❑ COMMERCIAL_ ELECTRICAL APPLICATION: 'INFORMATION &;;DESCRIPTION OP WORK CONTRACT PRICE OF WORK: $ 8400,00 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Change of Contractor as Of 10/15/2020 for permit number E2001-075 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO [✓] YES - Select Scope: ❑ service ❑ Feeder ❑✓ Circuits-#: 10❑ 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: ✓ NO YES -- See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAG 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: ❑✓ NO DYES -See ❑ Betow & 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: Raya AlQuaysi TENANT BUSINESS NAME (If Commercial): Gyro House OWNER MAILING ADDRESS: STREET 12102 4th Ave W Apt # 23-101 c,N Everett STATE WA 21P 98204 OWNER PHONE: 425-595-8150 OWNER EMAIL: raya.afgaysi@yahoo.com CONTRACTOR NAME: Active Engineering CONTRACTOR ADDRESS: IT11I=_T6605 200th St SW CITY Lynnwood STATE WA ZIP 98036 CONTRACTOR PHONE: 425-776-8119 CONTRACTOR EMAIL: bmachovsky@activeengineering.nel CONTRACTOR LIC. #(REQUIRED): Active'088MS CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 26248 PRIMARY CONTACT: DOWNER RICONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Stuart Sankey AGREEMENT: i hereby cerlify that 1 have read and examined th' CONTACT PHONE: 206-571-2690 CONTACT EMAIL:SSankey@ActiveEnginearing.net V 1. s app rca ion and know 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 l am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT M Bryan Machaysky z:_;;;10/15_/2020 OwnerlAut ' ad Agent Signature Date . -� &"f 0 ?evise/20f9) Page 1