10115 HOLLY DR BLDG K OLIN FIELDS APTS 2021-12-17

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 i(E)everettepso@everettwa.gov I www.everettwa.govlpermits PROJECT SITE INFORMATION a �; PROJECT ADDRESS: 10115 Holly Drive Everett, WA 98204 Bldg. K _BUILDING AREA: 50 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION El ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX El ADU El MULTI-FAMILY-#OF UNITS:16 El COMMERCIAL ELECTRICAL.APPLICATIONINFORMgi 'ION V' p Ie A PRKV, CONTRACT PRICE OF WORK: $ 3,234.00 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:El Service El Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO Q YES-#of Devices: 2 SELECT SCOPE(REQUIRED): El Data El Intercom El Thermostat El Audio Secure Access El Security System 0 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): 4 , CODE COMPLIANC IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO El YES—See Below&Pg.2 II By checking this box, I am slating that I have read and understand all of WAG 296-46B-900,selected the specific reason on page 2 of this application(see next page),ANC/Plan Rev ew 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: ❑✓NO 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 n to receive an exemption from this licansingicertifcation requirement. OWNER NAME:AMC LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sFREET 10115 Holly Drive c,7, Everett STATE WA 98204 ztr> OWNER PHONE: 425- 341- 0146 OWNER EMAIL: olinfieldsmaintenance a@gmail.com CONTRACTOR NAME: Performance Systems Integration, LLC DBA Fire King of Seattle CONTRACTOR ADDRESS: STREET 240 S. Holden St. CITY SeattleSTATE WA zip 98108 CONTRACTOR PHONE:206- 763-4177 CONTRACTOR EMAIL: tmoore C7 firekingofseattle.com CONTRACTOR LIC.#{REQUIRED):PERFOSl831 PE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): bit fO 1 q PRIMARY CONTACT: ❑OWNER EICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206- 763-4177 Tam i Moore CONTACT EMAIL: tmoore@firekingofseattle.com AGREEMENT.I hereby certify that I have read and examined this application and know the same to be true and corrrect. 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 focal 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 t comply with the State Contractors Law 18.27 RCW and 296.200 WAC, City of Everett Official Use Only PERMIT#: \1AN\..,\ k.,,'',,Zr\60*-----\&•- ID 2- ‘C\ E 4t0 4� Owner/Authorized Agent Signature Date (Revised 111112019) Page 1-Application