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gn- tLECTRICAL PERMIT A PPLI,TION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everettepsgeverettwa.gov l www.evereitwa.gov/permIts
<br /> PROJECT ADDRESS: 11229 19th Ave SE BUILDING AREA: 30 sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑SFR ✓❑ TOWNHOUSE LI DUPLEX ❑ADU ❑ MULTI FAMILY #OF UNITS:32 ❑COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 20681.25 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK: •
<br /> �— —
<br /> Installation of low voltage gate and automation k J C- C.
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope:❑Service ❑ Feeder ❑Circuits-#, ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:20
<br /> SELECT SCOPE(REQUIRED):
<br /> ❑Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Secure Access ❑ Security System
<br /> ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> 2 Other(List All) Automated entrance gate 4 ypq�q
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<br /> Ivc�.'.11.�!1.,,W�3�.t..�.rh�:1..)..1.;:(�� I.��7�',,..11:.A.lI:I.�I.�u�:l�ylx�.,.la,.�.rdJ,�... .�,.,,< i�,;:u.:h.J:.:u..:: w�asua:k�..r.. A:i» �yk -d,Jfi
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ii NO 111 YES—See Below&Pg.2
<br /> ❑ 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
<br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO EYES-See Below&Pg.3
<br /> ❑ Pursuant to ROW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent, sale,or lease
<br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
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<br /> en
<br /> OWNER NAME: MUM Development & Constructio TENANT BUSINESS NAME(If Commercial):Silver Lake Townhomes
<br /> OWNER MAILING ADDRESS: STREET 19528 Ventura Blvd #573
<br /> ctn Tarzana STAY=CA ziP 91356
<br /> OWNER PHONE:818-744-1473 OWNER EMAIL:
<br /> CONTRACTOR NAME: Security Gate and Access, LLC
<br /> CONTRACTOR ADDRESS: STREET 5402 184th St E, Ste C
<br /> CITY Puyallup STATF WA „e 98375
<br /> CONTRACTOR PHONE:253-847-9362 CONTRACTOR EMAiL•Trudy@Sgawa.COrn
<br /> CONTRACTOR LIC.#(REQUIRED):SECURGA886KZ CITY OF EVERETT BUSINESS LIC.#(REQUIRLD):055293
<br /> PRIMARY CONTACT: ❑✓I OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:253-847-9362
<br /> Michael Maggitti CONTACT EMAIL:mm@sgawa.com
<br /> AGREEMENT:!hereby certify that t have read and examined this application and know the same to be true and correct. Ali provisions of laws and ordinances governing this
<br /> 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 stare or
<br /> 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
<br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> f 3/15/2019 E \ O ? - dqz
<br /> Owne 't z d Ag t Signature Date (Revised 1/11/2019) Page 1-Application
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