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

110 • ism ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-881D I FAX 425-257-8857 I(E)everetteps@everettwa.gov I wwweverettwa.govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: 10115 Holly Drive Everett, WA 98204 Bldg. F BUILDING AREA: 50 sq ft PROJECT TYPE: El NEW CONSTRUCTION LI ADDITION D TENANT IMPROVMENT LI REMODEL BUILDING USE: Ell SFR El TOWNHOUSE El DUPLEX El ADU MULTI-FAMILY-#OF UNITS:16 El COMMERCIAL ELECTRICAL,APPLICATION INFORMATION 41: „ow CONTRACT PRICE OF WORK: $ 3,582.00 ASSOCIATED BUILDING PERMIT#(if 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? NO El YES-Select Scope: E Service El Feeder El Circuits-#: E Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: 2 SELECT SCOPE(REQUIRED): 0 Data El Intercom El Thermostat El Audio El Secure Access El 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDIOR PERSONAL CARE FACILITIES: El NO ri YES—See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-468-900,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 DYES-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 licensinglcertification requirement. PNTACrOSINIRM:ATION: OWNER NAME: AMC LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10115 Holly Drive Everett STATE WA ZIP 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. CfTY Seattle STATE WA np 98108 CONTRACTOR PHONE:206 763-4177 CONTRACTOR EMAIL: tmoore@firekingofseattle.com CONTRACTOR LIC.#(REQUIRED):PERFOSI831PE CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 0 t Ai et 3 v PRIMARY CONTACT: DOWNER DCONTRACTOR DOTHER(Please Specify) CONTACT NAME, CONTACT PHONE: 206- 763-4177 Tami Moore CONTACT EMAIL: tmoore@firekingofseattle.com AGREEMENT:I hereby certify that I have read and examined this application and know the Seine to be true and comet. All provisions of laws and ordinances governing this type of work will be completed whether specified hatpin 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 1 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#: Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application