1118 80TH ST SW BASE FILE 2022-01-24

ELECTRICAL PERMIT APPLIRTION 4rErr CITY OF EVERETT PERMIT SERVICES 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 zI PROJECT SITE INFORMATION ti „ PROJECT ADDRESS: 1118 80th St SW Everett WA 98203 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 28,647.41 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Lighting Retrofit to existing fixtures located in office spaces, warehouse area, and exterior perimeter. Replacing interior fluorescent fixtures with new LED kits. Replacing existing exterior fixtures with new LED fixtures. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? Cl NO El YES-Select Scope: El Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El Intercom E 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. ❑Other(List All): CODE COMPLIANCE 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: ONO 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): Pepsi Beverages OWNER MAILING ADDRESS: STREET 1118 80th St SW CITY Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: All Star Lighting DBA Lights Inc CONTRACTOR ADDRESS: STREET3723 Serene Way cITY Lynnwood STATE WA ZIP 98087 CONTRACTOR PHONE:2069493188 CONTRACTOR EMAIL:)segura@lightsinc.com CONTRACTOR LIC.#(REQUIRED):LIGHTI*830R7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 59845 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2069493188 JUNIOR SEGURA CONTACT EMAIL:JSEGURA@LIGHTSINC.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 PERMITER #: 2.13.2020 ` � L✓ �' Owner/Authorized Ag ignature Date (Revised 1/11/2019) Page 1-Application