1001 SHUKSAN WAY US FOODS 2022-01-14

• ELECTRICAL PERMIT APPLICATION EVERETTCITY OF EVERETT PERMIT SERVICES 3200 - CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 1001 SHvK 5A1I WAY EVEQ<s-77 wA 902-03 BUILDING AREA: 156, 0-0 D sq ft PROJECT TYPE: NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL CONTRACT PRICE OF WORK:$ 500.o d ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: NOOK UP (,I) /F /LL ft1'N,f7EO St G,v 7o Ew67//vG Pa&)Ez 5,4Al Cc4.0 7 OO,t)E by d7#EIS 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 IP YES-#of Devices: Sr(on) SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑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. El Other(List All): OQE O,PAPa�. NCE 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-90 ,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:XINO 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. COI+t11OM4TON OWNER NAME: Foot] SEQv;GES of A-ni A. '.4 TENANT BUSINESS NAME(If Commercial): U S 'pot?S OWNER MAILING ADDRESS: STREET /91430 E Vl,t..L(c ' HIV,/ cnx IK.E n17 STATE Vk/A ZIP 9ba3 OWNER PHONE: d17 63 I 32-1 6 OWNER EMAIL: d - 0 M CONTRACTOR NAME: PLu,n 8 51 G,v S CONTRACTOR ADDRESS: STREET q09 5 . 2S7/i • ST y coy l A L(),rr 4 STATE wA ZIP 9 0 /D 91 CONTRACTOR PHONE: 253 1,73 33 2 3 CONTRACTOR EMAIL: 6/4 Gq e plli.✓1(7 Si"el.S• Ca.., CONTRACTOR LIC.#(REQUIRED): PL0/7)35/077 W S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): '9e28 S PRIMARY CONTACT: DOWNER ' CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253 1/73 33 La E-X7 't/-3 BRIAN f3R0SNAN CONTACT EMAIL: br;a/1 & phi Alb6.'994s. Go 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 l 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#: ' C -0 5� 6.3.19 E 1 0 Own zed Date (Revised 1/11/2019) Page 1-Application