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•MIN <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WAS GTON (13)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwagov I www.everettwa.govipermits <br /> HIN <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 10115 Holly Drive Everett, WA 98204 Bldg. Q BUILDING AREA: 50 soft <br /> PROJECT TYPE: E] NEW CONSTRUCTION El ADDITION Ei TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: El SFR El TOWNHOUSE [1 DUPLEX El ADU El MULTI-FAMILY-#OF UNITS:16 El COMMERCIAL <br /> ELEsTRICALAMWPATIO1NFOltmATION& DESCRIPTION OP WORK <br /> CONTRACT PRICE OF WORK: $ 3,234.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install fire alarm control panel and install AES radio within a NEMA-4 enclosure. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO E YES-Select Scope: LI Service El Feeder ri Circuits-#: LI Complete Re-wire <br /> LOW VOLTAGE WORK? El NO E1' YES-#of Devices: 2 <br /> SELECT SCOPE(REQUIRED): El Data El Intercom Ej Thermostat rj Audio El Secure Access E Security System <br /> El 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 /> LI Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: El NO in YES--See Below&Pg.2 <br /> 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 <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, <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg. 3 <br /> Pursuant to RCW 1928.261„property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am 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 /> ,• — ‘'qcoNTA±4.12, ,. #11MON <br /> OWNER NAME:AMC LLC TENANT BUSINESS NAME(If Commercial): <br /> ,OWNER MAILING ADDRESS: STREET 10115 Holly Drive <br /> Everett <br /> sTATE WA ZIP 98204 <br /> OWNER PHONE: 425- 341- 0146 OWNER EMAIL: olinfieldsmaintenance@gmail.com <br /> - . <br /> CONTRACTOR NAME: Performance Systems Integration, LLC DBA Fire King of Seattle <br /> CONTRACTOR ADDRESS: STREET 240 S. Holden St. <br /> crry Seattle <br /> STATE WA ZIP 98108 <br /> CONTRACTOR PHONE:206- 763-4177 CONTRACTOR EMAIL: trn0Ofegfireking0fSeaftle.COM <br /> CONTRACTOR LIC,#(REQUIRED):PERFOSI831PE CITY OF EVERETT BUSINESS LIG,#(REQUIRED): (p 3 <br /> PRIMARY CONTACT: DOWNER ECONTRACTOR EOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206- 763-4177 <br /> Tami Moore CONTACT EMAIL: tmoore@firekingofseattle.corn <br /> AGREEMENT: 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 <br /> type of work wilt be OOMPloted whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the previsions of any other state or <br /> 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 <br /> comply with the State Contractors Law 18.27 RCVV and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> E <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />