406 SE EVERETT MALL WAY CALIFORNIA TINT 2022-04-05

.ECTRICAL PERMIT APPI•ATION 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: 406 SE Everett Mall Way BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 100 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install one lit wall sign THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: CIService CIFeeder ❑ Circuits-#: ❑ Complete Re-wire — LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ 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. ❑ Other(List All): 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: California Tint TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 406 SE Everett Mall Way CITY Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: NW Signs CONTRACTOR ADDRESS: STREETS 7201 Beaton Rd SE CITY Monroe STATE WA zip 98272 CONTRACTOR PHONE:425.844.6415 CONTRACTOR EMAIL:traCle@nwsigns.Com CONTRACTOR LIC.#(REQUIRED):nwsigs*84201 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):53882 PRIMARY CONTACT: CI OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) - CONTACT NAME: CONTACT PHONE:425.844.6415X17 Tracie Skiles CONTACT EMAIL:tracie@nwsigns.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 lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: (7)/ 7 ( r / ( Zz— E - S9 Owner/ thorized Agent Signature Date (Revised 1/11/2019) Page 1-Application