1121 SE EVERETT MALL WAY SNOPAC 2021-11-02

ILZ ECTRICAL PERMIT APPLI TION 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: 1 123 SE Everett Mall Way #200 BUILDING AREA: sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ❑REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 4,500.00 ASSOCIATED BUILDING PERMIT#(if applicable): M1905-059 DESCRIBE SCOPE OF WORK: Circuit to new Liebert unit and 2 circuits to roof fans THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope: El Service El Feeder ❑Circuits-#:3 El Complete Re-wire LOW VOLTAGE WORK? El NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom El Thermostat ❑Audio El Secure Access El 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO El 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: ENO EYES-See Below&Pg.3 ' 1 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: City of Everett TENANT BUSINESS NAME(If Commercial):SnoCom 911 OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Dahl Electric CONTRACTOR ADDRESS: STREET3409 McDougall Ave CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE:4255-252-1700 CONTRACTOR EMAIL:dstevens@dahlelectric.com CONTRACTOR LIC.#(REQUIRED):Dahleei926qd CITY OF EVERETT BUSINESS LIC.#(REQUIRED):037-024 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-661-0511 Dan Stevens CONTACT EMAIL:dstevens@dahlelectric.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 ie made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official'Use Only PERMIT#: IL - �� E1� 4'1 - 155 Own thorized Agent Signature Date (Revised 1/11/2019) Page`l-Application