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RECTRICAL PERMIT APPLItli' TION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> al1t , 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everetwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 11229 19th Ave SE BUILDING AREA: 30 sq ft
<br /> PROJECT TYPE: O NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑ SFR ✓❑TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY #OF UNITS:32 El COMMERCIAL
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<br /> CONTRACT PRICE OF WORK:$ 20681.25 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> Installation of low voltage gate and automation
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ✓❑NO ❑ YES-Select Scope:Cl Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices:20
<br /> SELECT SCOPE(RtQUIRED):
<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 /> Cl Other(List All):Automated exit gate g
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<br /> iS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: I NO III 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 riot
<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 /> I Pursuant to RCW 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 l have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification
<br /> requirement.
<br /> e ainga tr n Y i hi l 1kka d 3 ,antm MO MMEM INV
<br /> OWNER NAME: MVM Development & Constructio TENANT BUSINESS NAME(If Commercial):Silver Lake Townhomes
<br /> OWNER MAILING ADDRESS: SWEET 19528 Ventura Blvd #573
<br /> Tarzana STATE CA z,p 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 STATE WA zip 98375
<br /> CONTRACTOR PHONE:253-847-9362 CONTRACTOR EMAIL:Trudy©sgaWa.Com
<br /> CONTRACTOR LIC.#(REQUIRED):SECURGAS86KZ CITY OF EVERETT BUSINESS LIC-#(REQUIRED):055293
<br /> PRIMARY CONTACT: DOWNER ❑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 i have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or riot. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state 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 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> 3/15/2019 E E 6\
<br /> 03 -c °\
<br /> Own Authoriz d A ent Signature Date (Revised 1/11/2019) Page 1-Application
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