5415 EVERGREEN WAY COASTAL COMMUNITY BANK 2022-02-02

ill _ r EVERETT WASHINGTON ELECTRICAL PERMIT APPLICATION 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 1PROJECT ADDRESS: bLI Irn Nuafun � BUtLDIN0 AREA: sq It 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: $ t.-. q ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Ul uj I- 1 1 A W\Y'D-. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO DYES -Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO OYES- # 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 Ail): CODE COMPLIANCE i3 THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FAGILITIES: s NO YES -- See Below & Pg, 2 By checking this box, I am stating that I have read and understand all of WAC 296-468-900, 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: 7NO 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: TENANT BUSINESS NAME if Commercial): OWNER MAILING ADDRESS: s-mEET C39 Q, , C , STATE `td 1 B ZIP 4X ,��CITYt OWNER PHONE:Vi' OWNER EMAIL: ,,aCC) rn CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET py �yV( /`� CITY STATE t,,;..3 ..ZIP �. 4✓S. CONTRACTOR PHO : 1 (? �_ Cl2 CONTRACTOR EMAIL: tA6CWK Cc(yt2 CONTRACTOR LIC. #(REQUIRED): ;t -`-i � C( `( CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: COWNER CONTRACTOR ❑OTHER (Please Specify)_ } CONTACT NAME: w CONTACT PHONE, ` CONTACT EMAIL: Arr prOvrswns Of laws and ordinances govaming this -.t type of work WHI be completed wheth led herein or not. The granting of a permit does not presume to give authorfty to violate or cancel the provisions of any other state or local law regulating construdlon ha perfonn�nca ction. That I am authored by the owner of this property to perform the work for which application Is made and 1 comply with the State Contra ors Law 18.27 R d 296.2 C. Cat of Everett Official Use Only PERMIT #: Ow ! razed Agent Signaler Date (RevisedTi 712019) Page 1-Appitcatlon