8530 EVERGREEN WAY FRED MEYER 2021-11-02

• ELECTRICAL 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 477 ::PROJECT!SITE INFORMATIONi .,.. PROJECT ADDRESS: 8530 Evergreen Way BUILDING AREA: 2000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT El REMODEL BUILDING USE: El SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL AP ,:ppATION INFORJV ATION &DESCRIPTION O C#RI! CONTRACT PRICE OF WORK: $ 2000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Pull cat5e to each entrance/exit door(daisy chain). Install camera and gatekeeper equipment at doors. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices:3 SELECT SCOPE(REQUIRED): Ill Data ❑ 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 location and installation approval. ❑Other(List All): y }► ,.. ... ,', i ODE COMPUICE_..:'r .. , IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: n NO E1 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 fI 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: Fred Meyer TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 8530 Evergreen Way ,,T,, Everett STATE Wa Z,E 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Applied Telecom Systems CONTRACTOR ADDRESS: sTREET701 5 SW McEwan Rd CITY Lake Oswego STATE Wa ZIP 97035 CONTRACTOR PHONE:503-684-961 1 CONTRACTOR EMAIL:sbates©atsdata.com GG// CONTRACTOR LIC.#(REQUIRED):APPLITS066KD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 2Ci O�0'I PRIMARY CONTACT: DOWNER I CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:503-793-7421 Steve Bates CONTACT EMAIL:sbates@atsdata.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 properly 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#: Steve Bates r i Z/241lf' E l9.02 - 11 { Owner/Authorized'Agant Signat Date (Revised 1/11/2019) Page 1-Application