7710 EVERGREEN WAY FELLOWSHIP CHRISTIAN SCHOOL 2022-05-13

ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION /111.0.,„.....4 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT.WA 98201 w.... ...7- (P)425-257-8810 I FAX 425-257-8857 I (E)everettepsgeverettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION eV()3 PROJECT ADDRESS: 1 1, i C EV/el"ey ck,,,,,4„ 1 ),,k1 Euteyell Cf /A C?,, .-- PROJECT TYPE: NEW CONSTRUCTION ADDITION [3 ENAT IMPROVMENT ZI REMODEL rt-31 BUILDING USE: DISFR 13 TOWNHOUSE E3 iliPLEX 01kDU 0 MULTI-FAMILY-#OF UNITS: 12 COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$1 1,345.00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO DYES-II OF DEVICES: IS THIS A FIRE ALARM PERMIT? 1;3 O CI YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: I need to change scope of work for Inspector on permit number E1809-139 Run power for 2 drinking fountains circuit # 1 and 36 Pan& A THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ZSBy checking this box, I am stating that I have read and understand all of WAC 296468-900,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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: trPursuant 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. s , CONTACT INFORMATION OWNER NAME: Lane Properties LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10515 Evergreen Way cm, Everett STATE WA ZIP 98204 OWNER PHONE: OWNER EMAIL: . . CONTRACTOR NAME: D & E Electric, Inc. CONTRACTOR ADDRESS: STREET 4220 166th Ave East c,„ Lake Tapps STATE WA ,,,, 98391 CONTRACTOR PHONE:253-891-4144 CONTRACTOR EMAIL: deelectric6792@comcastnet CONTRACTOR LIC.iltREQUIRED):DEELEI*039D6 CITY OF EVERETT BUSINESS LIC.#0:iEQUIRED): 053372 PRIMARY CONTACT: DOWNER ;1‘..:,'ONTRACTOR [I2:0THER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-606-0877 Ed Jensen CONTACT EMAIL: edjensen58@comcastnet 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 ern authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1 a27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# m i Owner/Authorized Agent/ ignature Date (Revised 10/30/2018) Page°I of 3 ) .',