2615 BROADWAY QFC 2021-09-22 - Laserfiche WebLink

mei ECTRICAL PERMIT APPL ..,ATION EVERETT CITY OF EVERETT PERMIT SERVICES 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 2615 Broadway BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE El DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Coorvec_k- (v 6 w Cep STD �F2oNT �t�� ,1 4-c) L-)( 44-(tikhr1 [ Lec -akcI - -- ( ac I'1-- THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1 SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System Cl 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):Sign CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ 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: ENO 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. CONTACT INFORMATION OWNER NAME: Sanford Marcia H Irrevocable TENANT BUSINESS NAME(If Commercial): QFC OWNER MAILING ADDRESS: STREET 1711 Terrace DR CITY Snohomish STATE WA ZIP 98290 OWNER PHONE:2539875909 OWNER EMAIL:Asl.santos.rob p©gmail.com CONTRACTOR NAME: Advanced Signs LLC CONTRACTOR ADDRESS: STREET1 37th St NW STE C crry Auburn ^ STATE WAn ZIP 98001 CONTRACTOR PHONE: Z 5 3-9 7-590 CONTRACTOR EMAIL: 4 5 L .5'>,4 N TO S ROB 6 rk ez-,1 C 0 n-• CONTRACTOR LIC.#(REQUIRED): I -D(.1 Pc NI 5 L Q 2 3 P? CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: El]OWNER C\ONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Z 5 3 _ Gt� _5 (r a 9 c)I3Ca SIGN]-D 5 CONTACT EMAIL: A 51 r,4) (& y7tu, ( -( ✓t" AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions a and ordinances governing this 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 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: y E \01 (-4 0 ed Age nature Date (Revised 1/11/2019) Page 1-Application