10115 HOLLY DR BLDG C OLIN FIELDS APTS 2021-12-16

I. I I ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 r ASHirioroN (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION, t PROJECT ADDRESS: 10115 Holly Drive Everett, WA 98204 Bldg. C 'BUILDING AREA: 50 PROJECT TYPE: C NEW CONSTRUCTION ElADDITION 0 TENANT IMPROVMENT ❑ REMODEL sq ft BUILDING USE: ❑SFR ❑TOWNHOUSE D.DUPLEX ❑ADU ✓CI MULTI-FAMILY-#OF UNITS:16 ELECTRICAL,�,PP ° ` El COMMERCIAL 1VIATION & DESCRIPTION'OF WO CONTRACT PRICE OF WORK: $ 3,582.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install fire alarm control pan& and install AES radio within a NEMA-4 enclosure. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO E YES-Select Scope: Q Service El Feeder El Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? Er NO YES-#of Devices: 2 SELECT SCOPE(REQUIRED): i_i Data ❑ Intercom E Thermostat El Audio ❑ Secure Access ❑Security System E 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO LI YES—See Below&Pg.2 { I 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 l 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: ENO EYES-See Below&Pg.3 IPursuant 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. f TA'. INiFQRI '1 OWNER NAME: AMC LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10115 Holly Drive CITY Everett STATE WA zip 98204 OWNER PHONE: 425- 341- 0146 ,OWNER EMAIL: olinfieldsmaintenancet'c�gmall.com CONTRACTOR NAME: Performance Systems integration, LLC DBA Fire King of Seattle CONTRACTOR ADDRESS: STREET 240 S. Holden St. CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE:206- 763- 4177 'CONTRACTOR EMAIL: tmoore@firekingofseattle.com CONTRACTOR LIC,#{REQUIRED):PERFOSl831 PE +CITY OF EVERETT BUSINESS LIC,#(REQUIRED): 4 t" (1) 3 PRIMARY CONTACT: ❑OWNER E1CONTRACTOR [OTHER(Please Specify) CONTACT NAME: Moore PHONE: 206- 763- 4177 TCa' m i Moore CONTACT EMAIL: fmoore@firekingofseattie.com AGREEMENT.'I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this • type of work wilt 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: E Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application