10200 19TH AVE SE COSTCO HEARING CENTER 2022-01-21

• • ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WAS NING70N (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www everettwa.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 10200 19th Ave SE BUILDING AREA: sq ft PROJECT TYPE: Cl NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑✓ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE Cl DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1,500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install New Fire Alarm Device for Hearing Booths. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑Service Cl Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:3 SELECT SCOPE(REQUIRED) ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑Security System 0 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 ❑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 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: ❑✓NO EYES-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: Costco Wholesale Corp. TENANT BUSINESS NAME(If Commercial): Costco OWNER MAILING ADDRESS: STREET 999 Lake Dr CITY Issaquah STATE WA zIp 98027 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Fire Systems West, Inc. CONTRACTOR ADDRESS: sTREET206 Frontage Rd N, Suite-C CITY Pacific STATE VY,^r A Zip 98047 CONTRACTOR PHONE:253-833-1248 CONTRACTOR EMAIL:service@flresystemswest.Com CONTRACTOR LIC.#(REQUIRED):FIRESWI055LW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 022919 PRIMARY CONTACT: ['OWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-951-6005 Matt Cadman CONTACT EMAIL:matte@firesystemswest.com AGREEMENT 1 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 complfiirsd 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 stale or local law regulating conpfii/etion 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 PE i PERMIT# 09/25/2019 E co l-^' Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application