7621 EVERGREEN WAY PLANET FITNESS 2022-02-03

CI 1 Y Ui- EVhHh I r PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 u+rA 5 tt I N G T 01,1 (P) 425-257-8810 ( FAX 425-257-8857 I (E) everetteps@everettwa.gov I wuwv.everettwa.gov/permits PROJECT PROJECT ADDRESS: 7621 Evergreen Way BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION R1 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ®DUPLEX ❑ ADU ® MULTI -FAMILY - # OF UNITS: u COMMERCIAL ELECTRICAL FIB. ,<....... SCRIM TION OF WORK CONTRACT PRICE OF WORK: $ 50000 ASSOCIATED BUILDING PERMIT # (f applicable): 4 {DESCRIBE SCOPE OF WORK: Upgraded Locker Room Lighting Replaceing Treadmill Kneewall with low profile wire molding THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO YES - Select Scope: Q Service Q Feeder 21 Circuits4k 70 ❑ 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. s ❑ Other (List All): l IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: V 1V0 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. LARE:::::::RFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓ NO YES -See Below & Pg. 3 RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease proper electrical licensing and certification, or exemption. By checking this box, I am stating that 1 have completed and AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. OWNER NAME: TENANT BUSINESS NAME (If Commercial): Planet Fitness OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Skyline Electrical Services LLC CONTRACTOR ADDRESS: STREET113 Cherry St #75214 CITY Seattle STATE Wa z, 98104 CONTRACTOR PHONE:4252018288 1CONTRACTOR EMAIL:wende@skylinelectric.com CONTRACTOR LIC. #(REQUIRED):SKYLIES82ORD CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 60163 PRIMARY CONTACT: DOWNER ®CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Alex CONTACT PHONE:4256263679 CONTACT EMAIL: alex@skylinelectric.Com na, nuy —illy u,ai r mint wau amu examineo finis appucarion and Know me same ro era 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 violater or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authafied by the owner of ttNs prgmrfy to perform the work for which application is made and l comply with the State Contactors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only EEF� T #; o� Owner Autto rized Agbnt Signature Date (Revised 111112019) Page 1-Application /