12906 19TH AVE SE 2022-01-21 - Laserfiche WebLink

tit A. --- ECTRICAL PERMIT APPLICATION ,/� CITY OF EVERETT PERMIT SERVICES Lig - 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits * ��,°: PRO.IE0P SiTEANI:O'RMATI Nit; : ' 7 ' J PROJECT ADDRESS: 12906 BOTHELL-EVERETT HIGHWAY BUILDING AREA: 5000 sq ft PROJECT TYPE: El NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ElREMODEL BUILDING USE: El SFR El TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: El COMMERCIAL EL TRICAL APP UCATION';INEORMATION 8, DESCRIPTION O, WOR CONTRACT PRICE OF WORK:$ 1500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD RECEPTACLES IN PET FOOD AND DELI DEPARTMENT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ElYES-Select Scope: ❑ Service ❑ Feeder ElCircuits-#:3 El Complete Re-wire LOW VOLTAGE WORK? ElNO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom El Thermostat El Audio ❑Secure Access El 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. ❑Other(List All): • CODE COIV.E IANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO El 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: ENO 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. . : CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(If Commercial): FRED MEYER 0458 OWNER MAILING ADDRESS: STREET 12906 BOTHELL-EVERETT HIGHWAY CITY EVERETT STATE WA Z,P 98208 OWNER PHONE:425-357-2000 OWNER EMAIL: CONTRACTOR NAME: STONER ELECTRIC INC CONTRACTOR ADDRESS: STREET 1904 SE OCHOCO CITY MILWAUKIE STATE OR ZIP 97222 CONTRACTOR PHONE:503-462-6500 CONTRACTOR EMAIL:PERMITS@STONERGROUP.COM CONTRACTOR LIC.#(REQUIRED):STONEEC322PG CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 039886 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:503-462-6500 SARABETH DODD CONTACT EMAIL:PERMITS@STONERGROUP.COM 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 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 Tte PERMIT/V#: 10/31/2019 E ( U b Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application