1600 121ST ST SE 2022-05-02 - Laserfiche WebLink

maw ELECTRICAL PERMIT APPLIATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT.SITE INFORMATION PROJECT ADDRESS: 1600 121 ST ST SE, EVERETT, WA 98208 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ELECTRICALM UUCATIOK:INFORMATION &DERCRIP�' I N.OF WORK. CONTRACT PRICE OF WORK:$ 2500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: INSTALL (5) 20 AMP 120V DEDICATED CIRCUIT LED RETRO (10) 3 LAMP LIGHT POST. WO# 50163 TIM 206-406-4123 LOT LIGHTING RETROFIT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service El Feeder ❑✓ Circuits-#:5 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data [Intercom ❑Thermostat El 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. El Other(List All): CODE COMPUAI Cg ^. Ma..,??s; IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: a NO ri 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 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. 7 7 7 77 ,. CONTACT:INFORI1 OWNER NAME: VILLAGE AT CASPER'S TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1600 121ST STREET SE CITY EVERETT STATE WA Zip 98208 OWNER PHONE:425-348-8400 OWNER EMAIL: CONTRACTOR NAME: COCHRAN INC. CONTRACTOR ADDRESS: STREET 12500 AURORA AVE N _ CITY SEATTLE STATE WA Zip 98133 CONTRACTOR PHONE:206-368-199 CONTRACTOR EMAIL:JBBROWN@COCHRANINC.COM CONTRACTOR LIC.#(REQUIRED):COCHRi`oa8JS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19558 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR LIOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-406-4123 TIM WILLIAMSON CONTACT EMAIL:TWILLIAMSON@COCHRANINC.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 She State Contractors La 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: `� 11/3/19 E O ner/Authorized Agent ignature Date (Revised 1/11/2019) Page 1-Application