620 SE EVERETT MALL WAY BASE FILE 2022-03-11

4LECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION J PROJECT ADDRESS: 620 SE Everett Mall Way Unit 340 1 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATIONINFORMATION & DESCRIPTION OF. WORK CONTRACT PRICE OF WORK: $ 2500 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Install new counter plugs THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO 0 YES - Select Scope: ❑ Service ❑ Feeder 0 Circuits-#: 3 ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ 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: 0 NO LJ 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: 7NO 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: TENANT BUSINESS NAME If Commercial): Pacific Heights Homes OWNER MAILING ADDRESS: STREET 620 SE Everett Mall Way SIT,, Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Garvin Electric CONTRACTOR ADDRESS: STREETPO BOX 1932 CITY Marysville STATE WA ZIP 98270 CONTRACTOR PHONE:3606539435 1CONTRACTOR EMAIL: Amanda@garvinent.com CONTRACTOR LIC. #(REQUIRED):GARVIE1991CJ CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 039102 PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR []OTHER (Please Specify) CONTACT NAME: Paul CONTACT PHONE:4252103636 CONTACT EMAIL: paul@garvinent.COm H(.rcttmtiv i s / nereoy certify mat i nave read and examined tnis application and know the same to be true and correct. An 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 / 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 Owner/Authorized Agent Signature PERMIT #: E 2LO- ; Date (Revised 1/1112019) Page 1-Application