910 SE EVERETT MALL WAY VIBE TRIBE FITNESS 2022-01-12

`; ElfCTRICAL PERMIT APPLIOTION 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 SITE INFORMATION PROJECT ADDRESS: C) (0 ,5` e tfG((( Way BUILDING AREA: I SC() sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL . S(0 r) BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: rr-COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WOR CONTRACT PRICE OF WORK:$ 350 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 15-f—( I ' _W WC-WI CA SiC ) ) l --17 t r U iri i ti z,+Cc NO(id C_C�hc n i;.�` C( I m pc)ri 'rl\-) *- 0`r"V1eA- C1:: tvueo 1.4 i s Vic.1,1 - i:+, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? OTNO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: — ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO 12t YES-#of Devices: 1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secur: .. : sl feu ity System ❑ Fire Alarm-Installations under this permit only include electrical win ', r• h-i�f the sy tbp�. ' -• 'anal Fire Alarm Permit is required for review of device location and installation mg .val'JeP 0 Other(List All): i cl (-) i rl 3+-C'--A I LL y� p, . % i CODE COMPLIANCE 12r .fx pL, U IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: rJ NO EYEie�S t Ici 7 By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specifi ( on n page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections l at do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO OYES-See Below&Pg.3 n 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: 3-t c 1f?cie Yl U C -- TENANT BUSINESS NAME(If Commercial): V I b' —I�r)he -Ft-}i't('SS OWNER MAILING ADDRESS: 11 STREET ci ) C SE r!- ve rC(, r(Ct I( b'cau i)n it- f 0 1- cirr 4-L, ti- ' --er 4 STATE LC ` zip % o: OWNER PHONE: L C(1— 70 �}I C'}`7 I OWNER EMAIL: 4J e__T 9 l''.fl u D u C k co 9 irn CM . C OM CONTRACTOR NAME: (-t n{�--- (J C (l` (2-1 L S t; If)5-k--'t(\-0-) CONTRACTOR ADDRESS: STREET ( l,0',LI 9-. 6 C 1�r 1 t-v th /4l,v`tt � �{ p crry l(( \J t.�v STATE (.' - ZIP (7�C� ) li CONTRACTOR PHONE:Li 2.1,--3 Ct--"Al(T , CONTRACTOR EMAIL: bbh-t',;( 9r-i s U iQSIQ r CC4'f CONTRACTOR LIC.#(REQUIRED):'(Pi-7)j j js`t4 ci C/0 i Cy CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0 55 I C Lt PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) 5 i G.i-1 a rit-r CCU--C`( CONTACT NAME: CONTACT PHONE: LI 2_17—;---- s I — c 2.3 2 -Da vet. -c2e Ucknc t1 ph41 VcV1ci CONTACT EMAIL: cI c AGREEMENT:t hereby certify that I have read and exa ined 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#: .,____(// '') .7'47...z.)1..... /2r/21 E 2 I D d - 0 90 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application