3711 SMITH AVE 2022-05-24 - Laserfiche WebLink

EECTRICAL PERMIT APPLICATION 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 04ECTISIITE INFORM PROJECT ADDRESS: 3711 Smith Ave, Everett, WA 98201 BUILDING AREA: 500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL � ..,, ELECTRICAL APPLICATION tNFOAd>',. .; � ,n � .....` ��>P $ �.... .. ��;. CONTRACT PRICE OF WORK: $ 600.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Provided new Voice and Data cabling for 3rd floor office spaces THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:9 SELECT SCOPE(REQUIRED): ✓❑ Data ❑ Intercom ❑Thermostat ❑Audio El 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): 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 DYES-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. 1 'ACT Ili FO OWNER NAME: Everett Gospel) Mission TENANT BUSINESS NAME(If Commercial): Everett Gospel Mission OWNER MAILING ADDRESS: STREET 3711 Smith Ave CT- Everett STATE WA ZIP 98201 OWNER PHONE:425-740-2554 OWNER EMAIL:mblessum@egmission.org CONTRACTOR NAME: Fidelis CONTRACTOR ADDRESS: STREET 580 Industry Dr cm( Tukwila STATE WA ZIP 98188 CONTRACTOR PHONE:206-725-7728 CONTRACTOR EMAIL:customerservice@fidelisnw.com CONTRACTOR LIC.#(REQUIRED):EC FIDELC1921QR CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 052793 PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-725-7728 Brad McPherson CONTACT EMAIL:customerservice@FidelisNW.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 State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only r� PERMIT#: 54_ 1Q/2.d6e, 8/08/2019 ER b(0 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application