1801 BROADWAY WELLS FARGO BANK 2022-01-11

• S uni ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASH INGTON (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 801 Broadway BUILDING AREA: 14 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 17,450 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replace existing ATM with new ATM and surround and associated work. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑✓ Service ❑ Feeder ❑ Circuits-#: Cl Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio Cl 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):UPGRADE 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: ENO 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. CONTACT INFORMATION OWNER NAME: Wells Fargo Bank TENANT BUSINESS NAME(If Commercial): Wells Fargo Bank OWNER MAILING ADDRESS: STREET PO Box 2609 CITY Carlsbad STATE CA ZIP 92018 OWNER PHONE:n/a OWNER EMAIL:n/a CONTRACTOR NAME: CIM Group, Inc. CONTRACTOR ADDRESS: STREET960 E Discovery Ln CITY Anaheim STATE CA Z,p 92801 CONTRACTOR PHONE:(714) 956-2827 CONTRACTOR EMAIL: arios@cimgroupinc.com CONTRACTOR LIC.#(REQUIRED): CIMGRGI887JF CITY OF EVERETT BUSINESS LIC.#(REQUIRED): TBD PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify, V.I I Cc-'i t \ CONTACT NAME: CONTACT PHONE:(714) 768-6817 Andrea Rios CONTACT EMAIL:arios@cimgroupinc.com AGREEMENT:I hereby certify that/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 cat78tv'regulatip9 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 y with the taf Can actors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ---- - -------• f 08/10/2020 Epps l Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application