10200 19TH AVE SE COSTCO FUEL STATION 2022-01-21

OPECTRICAL PERMIT APPLIMITION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 99201 M (P)42S-257-8810 j FAX 425-2574857 j(E)everettepseteverettwa.gov ww&evetetteragovipermits WAS INGTON PROJECT SITE INFORMATION PROJECT ADDRESS: 10200 19th Ave SE BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ADDITION RI, TENANT OrIPROVMENT Li REMODEL BUILDING USE: 0 SFR El TOWNHOUSE El DUPLEX El ADU D MULTI-FAMILY #OF UNITS 73 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK "•;, CONTRACT PRICE OF WORK: 6-.1-5138 4 C C tr;L'flASSOCIATED BUILDING PERMIT*(if aPpliCable): DESCRIBE SCOPE OF WORK: GAS STATION: Extend (1)existing circuit for LED lighiting system at gas station canopy THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) UNE VOLTAGE WORK? El NO YES-Select Scope: El Service 0 Feeder 0 Circuits-#:1 D Complete Re-wire LOW VOLTAGE WORK? El NO E YES-#of Devices:24 SELECT SCOPE(REQUIRED): Data 0 Intercom 0 Thermostat 0 Audio El Secure Access El Security System El 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. o Other(ust.Ail)- : CODE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH ANDFOR PERSONAL CARE FACIUTIEE NO 0 YES--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 296-468-900,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: ONO DYES-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. COIkeT INFORMATION OWNER NAME: COSTCO Wholesale TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 999 Lake Drive Issaquah STATE WA = 027 OWNER PHONE 425/313-8100 OWNER EMAIL CONTRACTOR NAME: Interior Electric, Inc. CONTRACTOR ADDRESS: mai 21428 167th Ave SE VW Monroe STATE WA zo 98272 CONTRACTOR PHONE:4254783931 CONTRACTOR EMAIL:interiarelectric@aolcom CONTRACTOR LIC.*REQUIRED):INTERE1003CP CITY OF EVERETT BUSINESS LIC CREOutRED):044460 PRIMARY CONTACT: OOWNER OCONTRACTOR El OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425/478-3832 Wayne CONTACT EMAIL:interiorelectric@aolcom 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 riot presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the perfonnance of construction That lam authorized by the owner or this property to perform the Wort for which application is made and comply with the State Contractora Lew 18.27 RCW end 296,200 WAC, City of Everett Meet Use Only PERMIT#: IAA( 10125/2019 E iü - Owner/Authorized Agent Signature Date (Revised 1/11/2019) Pagel-Application - ,