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

MIN • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHNGTON (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwagov I www.everettwe.gov/perrnas I PROJECT :SITE INFORMATION PROJECT ADDRESS: 10115 Holly Drive Everett, WA 98204 Bldg. H BUILDING AREA: 50 sq ft PROJECT TYPE: LI NEW CONSTRUCTION El ADDITION Ell TENANT IMPROVMENT LIII REMODEL BUILDING USE: El SFR El TOWNHOUSE El DUPLEX D ADU MULTI-FAMILY-#OF UNITS:16 7 COMMERCIAL ELECTRICAL APPLICATIOWINFORMATION & DESCRIPTIONACWAR ( CONTRACT PRICE OF WORK:$ 3234.00 ASSOCIATED BUILDING PERMIT#Of applicable): DESCRIBE SCOPE OF WORK: Install fire alarm control panel and install AES radio within a NEMA-4 enclosure. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO LI YES-Select Scope: 1:1 Service El Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO YES-#of Devices: 2 SELECT SCOPE(REQUIRED): El Data n Intercom El Thermostat C3 Audio ED Secure Access EJ Security System El 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. Li Other(List All); • CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL HEALTH ANDIOR PERSONAL CARE FACILITIES: El NO in 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: ENO EYES-See Below&Pg.3 II Pursuant to RCW 19.28,261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease I 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: AMC LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1 0115 Holly Drive Everett STATE WA zu.98204 OWNER PHONE: 425- 341- 0146 OWNER EMAIL: olinfieldsmaintenance@gmail.com . „ CONTRACTOR NAME: Performance Systems Integration, LLC DBA Fire King of Seattle CONTRACTOR ADDRESS: STREET 240 S. Holden St. COY Seattle STATE WA Dp 98108 CONTRACTOR PHONE:206- 763- 4177 CONTRACTOR EMAIL: tmoore@firekingofseattle.com CONTRACTOR LIC.#(REQUIRED):PERFOSI831PE CITY OF EVERETT BUSINESS Lic.#(REQUIRED): 040 I • , , PRIMARY CONTACT: DOWNER DCONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206- 763-4177 Tami Moore CONTACT EMAIL: tmoore@firekingoiseattle.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 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 tilts 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 (100' I Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application