2415 COLBY AVE EVERETT HS CIVIC AUDITORIUM 2022-01-26

• • 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 I (E) everetteps@everettwa.gov I ew✓w.everettwa.gov/permits PRONET SITE INFORMATION PROJECT ADDRESS: 2415 Colby Ave Everett Wa 98203 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION Z TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 30 o ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Installation of telecommmunications cabling only - no devices installed by us Auditorium Bldg THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO [ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: E, Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Devices: No devices, just cabling 5 Gw(0Q, 1) lo��, 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 CO ' PLIANC ... p'117 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 296-46B-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: CINO 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: Everett School Distrtict q TENANT BUSINESS NAME (If Commercial); n: OWNER MAILING ADDRESS: SrHEET 3900 Broadway CITY Everett STATE WA Z,, 98204 OWNER PHONE:425-485- 1OWNER EMAIL: CONTRACTOR NAME: Skyline Communications CONTRACTOR ADDRESS:. sTRF_T12002 Beverly Park RD city Everett STATE WA 98204 CONTRACTOR PHONE:425-355-1593 1CONTRACTOR EMAIL:Chris.traCy@skylinecommunications.net CONTRACTOR LIC. #(REQUIRED): SKYL IC 193307 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 041057 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Chris Tracy CONTACT PHONE:425-583-7761 CONTACT EMAIL: Chris.tracy@skylinecommunicatiomns.n et -------r v , , t n{urevy Gunny than r nave raga and examined tms appattanon and know Jim same to be true and correct, All provisions df 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/ comply with the State Contractors Law 18.27 RCW and 296,200 WAG City of Everett Official Use Only PERMIT #: E rfo"7— �$i Owner/Authoriz4Agenti Date (Revised 11111201) Page 1_}tppiication