9506 19TH AVE SE THE JOINT 2022-03-03

•ECTRICAL PERMIT APPLI TION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 9506 19th Ave SE BUILDING AREA: 6,574 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: El SFR El TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1,100 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install two low voltage LED signs to east and west facing facades on the building and wire them into an already existing 20 amp dedicated sign circuit. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑ YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:2 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat ❑Audio ❑ Secure Access ❑ 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. ❑✓ Other(List All):Small LED Signs (2) 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 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: Conrad A. Topacio TENANT BUSINESS NAME(If Commercial): Shaun Preder OWNER MAILING ADDRESS: STREET 1833 North 105th Suite 303 CITY Seattle STATE WA ZIP 98133 OWNER PHONE:206-402-5567 OWNER EMAIL:smpreder@gmail.com CONTRACTOR NAME: Crossroad SIGN CONTRACTOR ADDRESS: STREET 16406 7th PL W CITY Lynnwood STATE WA ZIP 98037 CONTRACTOR PHONE:425-481-941 1 CONTRACTOR EMAIL:ryan@crossroadsign.COM CONTRACTOR LIC.#(REQUIRED):CROSSS*894M1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 63050 PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑✓OTHER(Please Specify) Project Manager CONTACT NAME: CONTACT PHONE:425-481-941 1 Ryan S h roy CONTACT EMAIL:ryan©crossroadsign.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 PERMIT#: /-2, 7,1 Owner/Auth�ed Agen gnature Date (Revised 1/11/2019) (Page 1-A lication pp