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ELECTRICAL PERMIT <br />APPLICATION <br />EVERETT <br />CITY OF EVERETT PERMIT SERVICES <br />F 32DO CEDAR STREET, EVERETT, WA 98201 <br />wnsHiNcron (P) 425-257-8810 I AX 425-257-8857 (E) everette s <br />p @everettwa gov I www.everattwa gav/pormits <br />�r�4��r srT,r;;°rr�tF <br />PRO,IECTADDRESS: 10115 Holly Drive Everett, WA 98204 Bid BUIL <br />PROJECT TYPE: C❑ NEW CONSTRUCTIONF" � BUILDING AREA 5Q <br />❑ ADDITION TENANT IMPROVMENT ❑ REMODEL. st1 ft <br />BUILDING USE: [� St"R ❑ TOWNHOUSE D DUPLEX ❑ ADU ✓ <br />1 MULTI-FAMILY <br />ECTRICAL APPLICATION INFORMATION, DESCR11i"�" �, UNIT5:1� �^^� <br />CONTRACT PRICE OF WORK: $ 3,582.00 R <br />1 COMMERCIAL <br />DESCRIBE OF WORK: <br />ASSOCIATED BUILDING PERMIT # (if appi cable): <br />S�UPE <br />Install fire alarm control p,en�l and install AES radio within a NEMA- 4 en <br />clostare. <br />HIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? NO <br />YES - select Scope: ❑ Service ❑ Feeder <br />LOW VOLTAGE WORK? NO ✓ ❑Circuits-#: [ Complete Re -wire <br />YES- # of uevlces: 2 <br />SELECT SCOPE (RE©UIRED); ❑ Data ❑ Intercom <br />Thermostat ❑ Audio ❑ Secure Access tt--II <br />t.._i Security System <br />0 Fire Alarm - installations under this permit only include electrical wiring rough -in of the system. An additional <br />Fire Alarm Permit is required for review of device location and installation approval. <br />Q Other (List All): <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES ✓ NO <br />YES ci See Below & Pg. 2 <br />By checking this box, I am stating that I have read and understand all of WAC 296-468-900, selected the specific reason <br />Of this application (see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not <br />See Page 2 require Plan Review, on page 2 <br />%RE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE, ✓ NC) <br />Pursuant to RCw 19.28.261_ property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />YES -See Below & Pg. 3 <br />without the proper electrical licensing and certification, or exemption. By checking this box, I arts stating that I have completed and <br />See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br />R NAME: AMC LLC <br />TENANT BUSINESS NAME (lf Commercial <br />MAILING ADDRESS: �rQ10115 Holly Drive <br />ern Everett STArE WA <br />'HONE: 425- 341- 0146 OWNER EMAIL: olinfieldsmaintenance@gmail.com <br />:TOR NAME: Performance Systems integration, LLC DBA Fire King of Seattle <br />;TOR ADDRESS: STREET 240 S. Holden St. <br />crTv Seattle _ <br />PHONE:206- 763.4177 CONTRAG <br />LIC. #(REQUIRED): PERFOS1831 PE <br />PRIMARY CONTACT: DOWNER <br />ACT NAME: <br />Tami Moore <br />sTATE WA <br />OF EVERETT BUSINESS LIC. <br />TOR DOTHER (Please Specify) <br />CONTACT PHONE. 206- 763- 4177 <br />CONTACT EMAIL: tf7loCsrf.nn firaleinnnfr, <br />and examined this applrcatir n and k0c <br />W 9 of work W11 be ctsnapteted cvhethar specified hereon or net: TThe granting of a p8rr, <br />cycat taw regulating 0onstftaGticxf artrie performance 0fo'nstructi0n. TTrat i aril author <br />:ornpty with the State Contractors Law T 8.27 RCW and 296,200 WAC. <br />twnerlAuthorized Agent Signature <br />Date <br />Coo <br />ZIP <br />ZIP 98108 <br />7as not r®surrre to _ ~ ,�•{� arry vrurrrances governing this -- <br />p g r lhOrrTy10 violate Or cancel the provisions afany other,tata or <br />by the owner of tlTis prpperty t0 perform the WM* for which application to made and i <br />Citv 0f Everett E1fflciat Use Only <br />PERMIT #: <br />E <br />(Revisrtri t�tTr�nro _ <br />