811 SE EVERETT MALL WAY BASE FILE 2021-11-10

• ELECTRICAL rERMIT & FIRE ALARM F'rcRMIT APPLICATION CITY OF EVERETT PERMIT SERVICES -14-1-7- 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 81 1 Everett Mall way PROJECT TYPE: NEW CONSTRUCTION ['ADDITION ® TENANT IMPROVMENT IIIREMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ 4DU ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 564 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? m NO ❑ YES-#OF DEVICES: `IS THIS A FIRE ALARM PERMIT? 0 NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Install 2 service receptacles near roof of building THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: la 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ® 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: RMD properties TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET PO Box 261 CITY Redmond STATE WA ZIP 98073 OWNER PHONE: 206-992-7334 OWNER EMAIL: rmdproperty@hotmail.com CONTRACTOR NAME: Rex Electric Service Inc. CONTRACTOR ADDRESS: STREET 11112 18th ST NE ,T Lake Stevens STATE WA ZIP 98258 CONTRACTOR PHONE: 425-422-1744 CONTRACTOR EMAIL: rriecks@gmail.com gmail.com CONTRACTOR LIC.#(REQUIRED): REXELES962N4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 48749 PRIMARY CONTACT: ❑ OWNER t DONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-422-1744 Robin Riecks CONTACT EMAIL: rriecks@gmail.com AGREEMENT.'I hereby certify that 1 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 with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# ,2,96 11-19-19 WI, \ ) -- \9 L Owner/Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3