1130 BROADWAY STE A EVERETT LAUNDRY 2021-11-01

Elm III ® 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 (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 130 Broadway Suite A BUILDING AREA: sq ft PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT I REMODEL BUILDING USE: ❑ SFR ❑I TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: k COMMERCIAL ELECTRICAL APPLICATION (INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 85 (ASSOCIATED BUILDING PERMIT#(if applicable): 'DESCRIBE SCOPE OF WORK: Install (1) LED wall sign display THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? n NO ❑ YES-Select Scope: n Service ❑ Feeder L Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 1 SELECT SCOPE(REQUIRED): LI Data Intercom ❑Thermostat ❑ Audio ❑ Secure Access ❑ Security System LI 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): LED CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: Er NO I 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: ❑✓ NO ❑YES-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: Dara Ouch TENANT BUSINESS NAME (If Commercial): Everett Laundry OWNER MAILING ADDRESS: STREET 1130 Broadway CITY Everett STATE WA ZIP 98201 OWNER PHONE:425.304.0749 OWNER EMAIL: CONTRACTOR NAME: BB&T Sign Services CONTRACTOR ADDRESS: STREET 16212 Bothell-Everett Hwy F239 CITY Mill Creek STATE WA ZIP 98012 CONTRACTOR PHONE:4253308160 CONTRACTOR EMAIL:bbtsiqnsmsn.com CONTRACTOR LIC.#(REQUIRED):BBTSIS*990P0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 055104 PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: CONTACT PHONE:'425'330.8160 Frank CONTACT EMAIL:bbtsigns msn.001'1'1 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 type or 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#: Christina Dahl 06/22/21 E 2t 0 co — 2 g Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application