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EVERETT <br />WASHINGTON <br />EWCTRICAL PERMIT APPLIONTION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 7807 Evergreen Way I Everett, WA 98203 1BUILDING <br />AREA: sq ft <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK: $ 250 <br />1ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: <br />Install two wall signs - hook up to existing electrical <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire <br />LOW VOLTAGE WORK? ❑ NO ❑ YES- # of Devices: <br />SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br />❑ Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional <br />Fire Alarm Permit is required for review of device location and installation approval. <br />❑ Other (List All): <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO Ll YES --See Below & Pg. 2 <br />❑ 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 <br />of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓ NO YES -See Below & Pg. 3 <br />❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br />See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br />CONTACT INFORMATION <br />OWNER NAME: DENH FLING INVESTMENT LLC TENANT BUSINESS NAME (If Commercial): Laundry Genius <br />OWNER MAILING ADDRESS: sTREET 3525 CHICAGO ST <br />,,n, Seattle STATE WA ZIP 98118 <br />OWNER PHONE:206 349-0358 <br />1OWNER EMAIL:DENHSIN@YAHOO.COM <br />CONTRACTOR NAME: Berry Sign <br />CONTRACTOR ADDRESS: ST1EET5002 S Washington St <br />CITY Tacoma STATE WA ... 98409 <br />CONTRACTOR PHONE:253 833-3600 <br />1CONTRACTOR EMAIL:mikel@berryslgn.COm <br />CONTRACTOR LIC. #(REQUIRED):Berryss853w7 <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 024786 <br />PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR []OTHER (Please Specify) <br />CONTACT NAME: <br />Mike Lee <br />CONTACT PHONE:253 232-5620 <br />CONTACT EMAIL:mlkel@berrySlgn.COm <br />AGREEMENT: 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />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 <br />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/ <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC City of Everett Official Use Only <br />PERMIT #: <br />1.4.2021 E <br />Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application <br />