3105 BROADWAY BROADWAY MARATHON 2021-11-01

tECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3105 Broadway BUILDING AREA: sq ft PROJECT TYPE: LJ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (N1 Freestanding Sign): Wire new Marathon LED gas price faces to existing electrical circuit. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 12v-60w LED SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Secure Access ❑ Security System El 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):2 @ 20amp Circuits(LED ILLUMINATION) 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: ONO 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: TSYH Corporation TENANT BUSINESS NAME(If Commercial): Broadway Marathon OWNER MAILING ADDRESS: STREET 3105 Broadway CITY Everett STATE WA ZIP 98201 OWNER PHONE:425-917-2109 OWNER EMAIL:steven@insigniasign.com CONTRACTOR NAME: Insignia Sign & Re-Imaging CONTRACTOR ADDRESS: STREET325 Burnett Ave N CITY Renton STATE WA ZIP 98057 CONTRACTOR PHONE:425-917-2109 CONTRACTOR EMAIL:steven@insigniasign.com CONTRACTOR LIC.#(REQUIRED):INSIGSR819L8 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): TBD FileLocal Site Down PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR L OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-917 2109 Steven Thomson CONTACT EMAIL:steven@insigniasign.com 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 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 PEERRMIT#: Steven Thomson 04/07/21 0 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application