1605 SE EVERETT MALL WAY WALMART 2022-01-14

RECTRICAL PERMIT APPLIPATION CITY OF EVERETT PERMIT SERVICES Of-E77 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 1(E) everetteps@everetfwa.gov I www,everettwa.gov/permits PROJECT ADDRESS. I i1?06 VrLr ' � 441; BUILDING AREA,. so fit PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TAANT tMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE O DUPLEX ❑ ADU ❑ MULTI -FAMILY - ## OF UNITS: COMMERCIAL ELECTRICAL APPLICATION IF0 , r . ,:. �� • 55, % CONTRACT PRICE OF WORK: aLoL t � ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? [ONO YES -Select Scope: N Service Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? 1PNO ❑ YES- ## of Devices: �t SELECT SCOPE (REQUIRED)} Data ElIntercom 71 Thermostat t-_I 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): IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL C;RE FACILITIES: NO 0 YES -- See Below & Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-9100, 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 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 El without the proper electrical licensing and certification, or exemption. By checking this bale, 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. CT i— T OWNER NAME: rq; - , TENANT BUSINESS NAME (if Commercial): : OWNER MAILING ADDRESS: STREET ii � vPrl�t d "lit. CITY STATE t` a' ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ' t{ °" " 1 CONTRACTOR ADDRESS: STREET It CITY t.t..l_vl ,. r STATE €Y,`'1.,_,. °•-i zip CONTRACTOR PHONE: - E CONTRAC i4 }R EMAIL;`• CONTRACTOR LIC. #(REQUIRED): - c LAE llalc CITY OF EVE14112iT BUSINESS LIC. #(REQUIRED): r PRIMARYCONTACT: DOWNER ICONTRACTO R []OTHER (Please Specify) ' CONTACT NAME: 0 CONTACT PHONE:, - L: CONTACT EMAIL: " '#ir zyc ki- -Kacmary i s r nerery Geniry inai i nave feae ano examineo ants appitcaricin ana Know ma same to to irae ana corrocr. Ati prowstons or taws ano orawanees governing this € 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 rl, law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application is made and 1 ipty with the State Contractors Law 18.27 RGWand 296.200 WAC, City of Everett Oftiai Uiie only PERMIT #: 6r a