9300 W MALL DR 2021-12-17 - Laserfiche WebLink

ESCTRICAL PERMIT APPLIOTION 4477- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION ' PROJECT ADDRESS: 9300 West Mall Dr BUILDING AREA: 500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION I—I TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX C ADU ✓❑ MULTI-FAMILY-#OF UNITS:200 ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 200.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Relocating 1 A/V device on the existing fire alarm system. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 1 SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom E Thermostat ❑Audio El Secure Access ❑ Security System ❑✓ 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. ❑ Other(List All): CODE COMPLIANCE! IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑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: ❑NO EYES-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 licensing/certification requirement. I'CONTACT INFORMATION OWNER NAME: West Mall Place Apts LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 219 E Garfield St STE 600 CITY Seattle STATE WA ZIP 98102 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Western States Fire Protection CONTRACTOR ADDRESS: STREET 14690 NE 95th St#101 CITY Redmond STATE WA ZIP 98052 CONTRACTOR PHONE:425-478-9709 CONTRACTOR EMAIL:seth.zehnder©wsfp.us CONTRACTOR LIC.#(REQUIRED):WESTESF906P1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 020553 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-478-9709 Seth Zehnder CONTACT EMAIL:seth.zehnder@wsfp.us 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 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 Ory(y bigttally signed by Seth Zehnder PERMIT#: Seth ZehnderDN C,je1E=Seth zehndre°2":: us, O=Western States Fire Protection, E _ [ ' I 'CN=Seth Zehnder U �,/tI Date:2020.10.07 10.06:00-07'00' 10/7/2020 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application