1520 BROADWAY 2021-12-13 - Laserfiche WebLink

0 ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa,govlpermits PROJECT ADDRESS: 1520 Broadway, Everett, WA 98201 BUILDING AREA NlA aq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL ELECTRICAL A , , _ :. N i NFORNIATIONi ;',DESCRIPTION WORK CONTRACT PRICE OF WORK: $ 700 ASSOCIATED BUILDING PERMIT # (if appltcable): N/A DESCRIBE SCOPE OF WORK: Replace existing roof top HVAC unit with new one. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 0 YES - Select Scope: ❑ Service ❑ Feeder 0 Circuits-M ❑ Complete Re -wire LOW VOLTAGE WORK? 0 NO ❑ YES- # of Devices: 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: MNO ✓_ 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: �'N0 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 Ilcensinglcertification requirement. "7`7 CONTACT INFORMAln N n OWNER NAME: Sunrise Services Inc. TENANT BUSINESS NAME if Commercial): Sunrise Comm. Mental Health OWNER MAILING ADDRESS: shirr 1520 Broadway cm Everett STATE WA DP 98201 OWNER PHONE:(425) 493-5870 OWNER EMAIL: N/A CONTRACTOR NAME: Seahurst Electric, Inc. CONTRACTOR ADDRESS: sTNE,,2915 Chestnut St. crry Everett STATE. WA aP 98201 CONTRACTOR PHONE:(425) 258-1882 1CONTRACTOR EMAIL:lnovy@seahurst.com CONTRACTOR LIC. #(REQUIRED :SEAHUE1099ON CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 18763 PRIMARY CONTACT: DOWNER QCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: CONTACT PHONE:(425) 258-5143 Dave LeBIanc ,CONTACT EMAIL:dleblanc@seahurst.com n�rcccrn�r• �. , rlvrvvy G- rwy user r nave reed ano ezanxnso rrus apprrcaoon anc anew me same tow true and correct. At/ provisions of laws and onftnances governing this type of work will he 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 or consGuction. 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 #: E �Lq0� _. ��j OwnerlAuth a Agent Signature Date (Revised 1/11/2019) Page 1-Applica lcai i