2405 BROADWAY 24 HOUR GROCERY 2021-09-22

E ECTRICAL 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 PROJR T SITE INFORMATION PROJECT ADDRESS: ).A gyy c;k iL Ve re - erg' BUILDING AREA: I). 1 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: _ COMMERCIAL ..:ELECTR[C/IL.APPL[CaT[ONw1.NFORMAT10fN S.;DES�Rt�PT[.t"�N,C�F.WraRN ...., ...::, CONTRACT PRICE OF WORK:$ `"; ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: VI) <<2(v,\I(7_ 0 V- A V v oLl: `R THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO KKES-Select Scope:❑ Service ❑ Feeder ❑ Circuits-#: ❑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): . ... �_. .�. �_.,:'_ ODE CaMPLIANC� IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: IfeLNO ❑YES—See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,se ected 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 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: . sget A TENANT BUSINESS NAME(If Commercial): `A 1' 9 c r� OWNER MAILING ADDRESS: STREET j -t9 11jyV 0,� ►,) C/ 1 � �qp CITY e TC.- STATE V. 4 ZIP I V )_ 0 OWNER PHONE 4 U OWNER EMAIL: CONTRACTOR NAME: L L- \ (� CONTRACTOR ADDRESS: STREET J i(JD 3 ,/\a,c 6 cn'r STATE UV ^� ZIP LL CONTRACTOR PHONE: I-{ -M-y7 �4 E CONTRACTOR EMAIL: 1 PEX- EL L f C Gf� �l Cjt V✓c`6t-t'( ' C p CONTRACTOR LIC #(R Q RED): 1 A-e7,-Pti_gi 27 r CITY OF EVERETT BUSINESS LIC.#(REQUIRED) PRIMARY CONTACT: 'P c NER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4�I 4-.2 -- 4 y g eLt CONTACT EMAIL: --) ( --0-72e+--e r_ ( V1� AGREEMENT:I 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 I 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 I am authorized by the owner of this property to perform the work for which application is made and I comply wit a State n ctors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ,°— E 19( 2 - \o Own Autho ed Agent Signature Date (Revised 1/11/2019) Page 1-Application