111 SE EVERETT MALL WAY BASE FILE 2022-04-28

EL•TRICAL PERMIT APPLIC1NON 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: 111 SE EVERETT MALL WAY ejJ0 L BUILDING AREA: 7742 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION n TENANTPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX C ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 14500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replacement of 90 T8 Fluorescent 4 Bulb troffer Light Fixtures with new Integrated LED troffer light fixtures. The new fixtures will utilize approximately 60% less energy than the existing fixtures. 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: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat E 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): 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: ENO RYES-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: Noya LLC TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 111 SE Everett Mall WAy CITY Everett STATE WA ZIP 98208 OWNER PHONE:877-622-2297 OWNER EMAIL:steven.warren@dep-i.com CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: El OWNER LJCONTRACTOR nOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:877-622-2297 Steven Warren CONTACT EMAIL:steven.warren@dep-i.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 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 State Contract s Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: _ � ` E rgo7 �J- ' -Owner/ orized Ag nt Signature Date (Revised 1/11/2019) Page 1-Application