1010 SE EVERETT MALL WAY AEROTEK 2021-11-02

® ELECTRICAL PERMIT APPLI•TIO EVERETTCITY 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: I ) t 0 5 i jig✓t t.,, i2 i/ (A 4-y BUILDING AREA: `:;, "e sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION Y1 ADDITION C TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ ( 7 S-' , '`t'Z ASSOCIATED BUILDING PERMIT#(if applicable): r L DESCRIBE SCOPE OF WORK: (j U U , L -L -e 0 ct�I Ems. ,i ---.- -i cs " I.< THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) iActon eon LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: .5 (, SELECT SCOPE(REQUIRED): rgData ❑ 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 loca)ion and installation approval. ❑ Other(List All): o i+r! Iyl �i cc7 Ul,f S 6:- CODE COMPLIANCE` IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El 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 „ 7OWNER NAME: c�'ro--"Yr� TENANT BUSINESS NAME(If Commercial): ..s OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Ili p ' 6 c Yvi ✓n L.,,L.; C.c, =‘,, L ln._s � �--- / CONTRACTOR ADDRESS: STREET ! / 2 L-c- ✓r-Q,-✓I �7 Y1 Ct v 12 6�y r CITY L-.1 'ei�/1 1= c ~ STATE )A-- ZIP S 2_CONTRACTOR PHONE:'Lit c rim 2 7 Y , (CONTRACTOR EMAIL: /44,i,(t,p,12 k r •- �Lt c;( cc:,w—t CONTRACTOR LIC.#(REQUIRED) in ('/vC u G el-- l/W.-6-A- CITY OF EVERETT BUSINESS LIC #(REQUIRED): f 'i ' PRIMARY CONTACT: ILIOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: / L C'//' 0 ( /// Z 7 y&" 'f 1 i G"I�<t-C ( K (�, CONTACT EMAIL: iM /� Y d/14 C �L c, C �'�/ AGREEMENT:I hereby rtity that I have read and examined this application and know the same to be true d c rrect. 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 PERMIT#: 2-9-.� �� E .cod -- Zak 2Z Ov(rner/Rhorized gent Slgn att Date (Revised 1/11/2019) Page 1-Application