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ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32 CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> . ..PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2930 Wetmore Ave BUILDING AREA: 500 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL <br /> ELECTS 1,1ICATION INFORMATION & ©ESCRIPTJONF WORK <br /> CONTRACT PRICE OF WORK: $ 10500 . 00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Replacing FACP and voice amplifiers that are not working properly. All field devices will remain. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO EYES-#of Devices:6 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br /> ✓❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> e ` *ICE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: r✓❑ NO U YES--See Below&Pg.2 <br /> ❑ <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg.3 <br /> ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> C' ' ACT INFORMATION .. <br /> OWNER NAME: City of Everett TENANT BUSINESS NAME(If Commercial): Everett Municipal Building <br /> OWNER MAILING ADDRESS: STREET 3200 Cedar St <br /> cm Everett STATE WA Z,P 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Western States Fire Protection <br /> CONTRACTOR ADDRESS: STREET14690 NE 95th St#101 <br /> crry Redmond STATE WA zip 98052 <br /> CONTRACTOR PHONE:425-881-0100 CONTRACTOR EMAIL:Seth.Zehnder C/wsfp.Us <br /> CONTRACTOR LIC.#(REQUIRED):WESTESF906P1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):20553 <br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-478-9709 <br /> Seth Zehnder CONTACT EMAIL:Seth.Zehnder@wsfp.us <br /> 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 <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERM <br /> IT#: <br /> 2/17/2020 ` 2_- <br /> Owner/ uth ed Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />