12902 19TH AVE SE GENUINE SMILE DENTISTRY 2022-03-03

(ItECTRICAL PERMIT APPLICAON 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: 12902 Bothel Everett Hwy, Suite E BUILDING AREA: sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL ELECTRICAL APPLICATION INFORMATIONS DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 300 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Hook up electrical sign to existing sign circuit. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope:❑Service El Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO E YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑ Secure Access El 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. 0 Other(List All): hook up sign to existing circuit. CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO CI YES—See Below&Pg.2 nI I 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:ONO 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:Jade Gan TENANT BUSINESS NAME(if Commercial):Genuine Smile OWNER MAILING ADDRESS: STREET 12902 Bothel Everett Hwy, Suite E CITY Everett STATE WA ZIP 98208 OWNER PHONE:(425) 367-0303 OWNER EMAIL:]adeganddS@gmail.com CONTRACTOR NAME: Shawn Spencer CONTRACTOR ADDRESS: STREET 23425 53rd AVE. SE CITY Bothel STATE WA ZIP 98201 CONTRACTOR PHONE: 425-449-0277 CONTRACTOR EMAIL: Spencfab@aol.Coal CONTRACTOR LIC.#(REQUIRED): SPENC"842KF CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: Cl OWNER ECONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206-468-3999 Tony Le CONTACT EMAIL: ussignllc@gmail.com AGREEMENT:1 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 with the Stale Contractors Law 8.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: jr. 9/9/2 02 0 E l 1&?) Own r Authorized Age t Signature Date (Revised 1/11/2019) Page 1-Application