7909 BROADWAY 2022-01-11 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITI k: r PROJECT ADDRESS: 7909 Broadway Everett, WA 98203 BUILDING AREA: 10000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICAT .ORMATIION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 20,000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Installations of camera system and keypads THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? n NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:14 SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑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 LJ 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 v 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 ON1ACT INFORMATION 1,7 , OWNER NAME: Natalie La Chapelle TENANT BUSINESS NAME(If Commercial): BH/Peoples Storage OWNER MAILING ADDRESS: STREET 22508 76th Ave West orry Edmonds STATE WA ZIP 98026 OWNER PHONE:425-775-5616 OWNER EMAIL:natalie@pe0plesstOrage.COm CONTRACTOR NAME: Far West Technologies CONTRACTOR ADDRESS: sTREET606 E Main St C,Ty Puyallup STATE WA ZIP 98372 CONTRACTOR PHONE:253-268-5379 CONTRACTOR EMAIL:pablor@farWeStteChn0l0gieS.COm CONTRACTOR LIC.#(REQUIRED):FARWEWT898MJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):051419 PRIMARY CONTACT: DOWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206.718.6308 Tim Biddick CONTACT EMAIL:timb@farwesttechnologieS.com 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 Only PERMIT#: rtiV!'1/3 l.GiCit.C.k 7.15.2019 F` Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application