9600 SHARON DR EXPLORER MIDDLE SCHOOL 2022-03-11

`I RECTRICAL PERMIT APPLIIIIIIIPATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 9600 Sharon Dr Everett, WA, 98204 BUILDING AREA: 2000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ✓0 COMMERCIAL ELECTRICAL APPLICATION ;INFORMATION 8 DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 50.00 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: head end connections - joint venture with McGann Electric THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Devices: 18 SELECT SCOPE (REQUIRED): ❑ 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): 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 296-4613-900, 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: ✓ NO YES -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: Mukllteo School District TENANT BUSINESS NAME If Commercial): Explorer Middle School OWNER MAILING ADDRESS: STREET 9600 Sharon Dr CITY Everett STATE WA zlp 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ADT COMMERCIAL CONTRACTOR ADDRESS: STREIT21312 30TH DR SE STE 103 CITY Bothell STATE WA Zlp 98021 CONTRACTOR PHONE: 425 375 4545 CONTRACTOR EMAIL: michelleburkhart@adt.com CONTRACTOR LIC. #(REQUIRED):ADT000L801UQ CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 62267 PRIMARY CONTACT: DOWNER ZCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Michelle Burkhart AGREEMENT- / herehv rartifii that 1 h— .e n.i ; 4- CONTACT PHONE: 425 375 4545 CONTACT EMAIL: michelleburkhart@adt.com _ ,. ,,,, Nrumwuns ur iaws ano 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERM #. 08-11-2020 E V1 noi Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application