2405 BROADWAY 24 HOUR GROCERY 2021-09-22

o 0 • IC ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PREClI'SIT,E�INFORMATION ,. PROJECT ADDRESS:t H l,/5 arU��a - LU2,st kt WA 10��BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: MOMMERCIAL .!.EI.EC'FRIPAL APPLICATi0Ik1 INFaRMAT1E N 8„DE, I tP''C ON ELF flfFt Rl CONTRACT PRICE OF WORK:$ y S-0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: A nInk t it e—e`mod t\--Q S ( aC7 A M ) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPL LINE VOLTAGE WORK? ❑ NO El YES-Select Scope: ❑Service ❑ Feeder Circuits-#: ( L )ompiete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): CI Data CI Intercom El 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,COMPUA NCE 4. m_ :.._:.;. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: RI NO ❑YES--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 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: II NO EYES-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. ; *Ai,. T 1'NFt RMATIONVi, a OWNER NAME: \RC ( k� S \1) (0 N NT BUSINESS NAME(If Commercial): � L �� roc Qf 5� ' % u �� OWNER MAILING ADDRESS: STREET � J ciTYY • 1 \A p...,— STATE� A- ZIP CA. 0-3 OWNER PHONE:p . i �'lc 4� OWNER EMAIL: \a` , , _ ,p. . �. _a.�, , ..�.� ._. ,,.u_..,�. CONTRACTOR NAME: CPI �(in a C4a\w c \ C,v l� CONTRACTOR ADDRESS: STREET `dot' C ) . Ur\4 ' \\ v / CRY y V \ 1' STATE ` V ZIP( �r � CONTRACTOR PHONE: CONTRACTOR EMAIL: `J CONTRACTOR LIC #(REQUIRED) Q(`'Mc ,\AK CITY OF EVERETT BUSINESS LIC #(REQUI ): PRIMARY CONTACT: LJOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT f NAM : p CONTACT PHONE: L c - a 1- 1 . )ti ` :► Jl V �"�, , 7 CONTACT EMAIL: Cc kiY 1S�'n�� t\e_Cl T.\ c(3) v- I), C u- n�� AGREEMENT::I hereby certify that I have read and examined this application and know the same to be true and correct. Af1'provisions of laws and ordinan s governing this type of work will be ompleted 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 regulatin onstruction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I h the S a e C tractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 1 S , c) ) c. E \S 2. - 02A (Revised 1/11/2019) 1-A lication caner/Author d Agent Signature Date Page 9 pp