2121 W CASINO RD WSIPC 2021-11-15

ftECTRICAL PERMIT APPLOATION 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: 2121 W Casino Rd BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑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:$ a,000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Installation of Replacement indoor Liebert system with new electrical lines THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO RYES-Select Scope: ❑Service ❑ Feeder ❑Circuits-#: 74 Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom XThermostat ❑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 COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO CI YES--See Below&Pg.2 rII 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:ZNO EYES-See Below&Pg.3 I I 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: TENANT BUSINESS NAME(If Commercial):WSIPC OWNER MAILING ADDRESS: STREET a 1 a 1 Cas►no Rd CITY Eveee kk STATE Y V A ZIP 8 o I OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Evergreen Eastside Heat and AC CONTRACTOR ADDRESS: STREET1811 130th Ave NE, Suite 101 CITY Bellevue STATE WA zip 98005 CONTRACTOR PHONE:(425) 968-8707 CONTRACTOR EMAIL:admin@eeheatac.com CONTRACTOR LIC.#(REQUIRED):EVERSSO2OT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):007955 PRIMARY CONTACT: ['OWNER ['CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425) 968 8702 Carrie D u rn e l l CONTACT EMAIL:carrie@eeheatac.com AGREEMENT:I hereby certify that/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 h the State C actors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Egja0 - \ Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application ' I