10200 19TH AVE SE 2023-01-26 - Laserfiche WebLink

`! ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 w�cuiun,nu (P) 425-257-8810 1 FAX 425-257.8857 1 (E) everetteps®evereM".gov I www.everettwa. govipermits PROJECT SITE,INFORMATION PROJECT ADDRESS: 10200 19th Ave SE, Everett, WA 98208 IBUILDING AREA: NA sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT 2 REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ® COMMERCIAL ...... ELECTRICAL APPLICATIONINFORMATIONAfitilL$CRIPTION OF, WORK CONTRACT PRICE OF WORK: $ 228,000.00 ASSOCIATED BUILDING PERMIT # (if applicable): NIA DESCRIBE SCOPE OF WORK: Relocate existing Electrical Room. 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: v SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ 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 - El Other (List All): _ CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 91 NO LJ YES — See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-4613-900, 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 YES -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: COstco TENANT BUSINESS NAME If Commercial): COStCO OWNER MAILING ADDRESS: s 10200 19th Ave SE ,. Everett STATE WA ye, 98208 OWNER PHONE:(425) 379-7451 OWNER EMAIL, NIA CONTRACTOR NAME: Seahurst Electric, Inc. CONTRACTOR ADDRESS: s,,,2915 Chestnut St. crry Everett STATE WA aP 98201 CONTRACTOR PHONE:(425) 258-1882 1CONTRACTOR EMAIL:lnovy@seahurst.com CONTRACTOR LIC. #(REQUIRED):SEAHUE1099QN ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 18763 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR QOTHER (Please Specify) CONTACT NAME: Dave LeBlanc CONTACT PHONE:(425) 258-5143 CONTACT EMAIL:dleblanc�}aseahurst.com AGREEMENTI 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 wilt be completed whether specified herein or not The granting of a permit does not presume to give authority to violate or canoe! the provisions of any other state or local taw rogula@ng construction or the performance of construction. That i am authorized by the owner of ihts property to perform the work for which application is made and t compty with the State Contractors Law 18.27 RCW and 296.200 WAC. C of Everett Official Use Ont PERMIT #: 21 Own@ Autho @d Allilent Signature Date (Revised 1/112019) Page 1-Application