12902 19TH AVE SE CULACCINO PIZZA AND PASTA 2022-03-03

ELECTRICAL PERMIT APPLICATION 477 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 12902 Bothell Everett Hwy, Suite D BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1,205 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Removing existing & Installing 1 Illuminated Wall Cabinet Sign on front facade, connecting to existing 20 amp dedicated circuit. Refacing existinig illuminated wall cabinet face on back of building. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO E YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑ YES-#of Devices: 1 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. ❑✓ Other(List All):Illuminated Wall Cabinet Sign,connecting to existing 20 amp dedicated circuit 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: AMANTE PIZZA & PASTA TENANT BUSINESS NAME(If Commercial): Culaccino Pizza and Pasta OWNER MAILING ADDRESS: STREET 12902 BOTHELL-EVERETT HWY STE D CITY Everett STATE WA ZIP 98208 OWNER PHONE:Katya Borisova 425 338 5600 OWNER EMAIL:kazalak1976@gmail.com CONTRACTOR NAME: BB&T SIGN SERVICES CONTRACTOR ADDRESS: STREET 16212 BOTHELL EVERETT HWY, STE F239 CITY MILL CREEK STATE WA ZIP 98012 CONTRACTOR PHONE: 425.330.8160 CONTRACTOR EMAIL:bbtsigns@msn.com CONTRACTOR LIC.#(REQUIRED): BBTSIS*990P0 EXP.3/9/2022 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425.330.8160 Frank Gonzales CONTACT EMAIL: bbtsigns@msn.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 Stat ractors Law 18.27 RCW 96.200 WAC. City of Everett Official Use Only PERMIT#: T�GLad - e Fastsigns Everett, A 11 24 2020 ❑12��5 Owner/Authorized Agent nature Date (Revised 1/11/2019) Page 1-Application