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ism <br /> I. ECTRICAL PERMIT APPLTION <br /> EVERETT CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHING TON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2505 Howard Avenue BUILDING AREA: sq ft <br /> PROJECT TYPE: NEW CONSTRUCTION ❑ ADDITION ❑✓ TENANT IMPROVMENT I—I REMODEL <br /> BUILDING USE: I SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 500.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Install AES Radio to monitor existing FACP <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ✓❑ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO [' YES-#of Devices 1 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br /> ❑✓ 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 /> ❑ Other(List All):_ <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑ 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: LINO EYES-See Below&Pg. 3 <br /> Pursuant to RCW 19.28.261, 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 /> it CONTACT INFORMATION <br /> OWNER NAME: Hopeworks TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2505 Howard Avenue <br /> cry Everett STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Guardian Security Systems <br /> CONTRACTOR ADDRESS: STREET 1743 1st Ave S <br /> cm( Seattle STATE WA ZIP 98134 <br /> CONTRACTOR PHONE:206-622-6545 CONTRACTOR EMAIL:efisher@guardiansecurity.com <br /> CONTRACTOR LIC.#(REQUIRED):GUARDSS233K5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 33443 <br /> PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-622-6545 ext 277 <br /> Elizabeth Fisher CONTACT EMAIL:efisher@guardiansecurity.com <br /> 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 <br /> 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 <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 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT)#: <br /> Elizabeth Fisher 1/5/21 E `SC <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />