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E IDECTRICAL PERMIT APPLOATION <br /> EVERETT 32 CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 4„, r .. PRO 1 - SITE NFORMA.....1 :------------- <br /> PROJECT ADDRESS: 4027 4th St SE Everett WA 98205 BUILDING AREA: 34,400 sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION 0 TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE El DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> ELE OF,WORK.., <br /> .. . �. ,1���►PPC�A'�" , 11NFORMJ�: �,DE$CRI[ .,.� � ° ,. ., <br /> CONTRACT PRICE OF WORK:$ 35,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Replacing existing FA systems on 7 buildings and networking back to main admin building. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? [' NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices:232 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio El Secure Access ❑ Security System <br /> 0 Fire Alarm- Installations under this permit only include electrical wiring rough-in of the system. An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑ Other(List All): <br /> DE COMPLIANCE , '� <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO ❑YES--See Below&Pg.2 <br /> ❑ 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO EYES-See Below&Pg. 3 <br /> ❑ <br /> Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFO MATION <br /> OWNER NAME: City Of Everett TENANT BUSINESS NAME(If Commercial): COE Water Pollution Control Facility <br /> OWNER MAILING ADDRESS: STREET 4027 4th St SE <br /> CITY Everett STATE WA ZIP 98205 <br /> OWNER PHONE:n/a OWNER EMAIL:n/a <br /> CONTRACTOR NAME: Western States Fire Protection <br /> CONTRACTOR ADDRESS: STREET 14690 NE 95th St Ste 101 <br /> CITY Redmond STATE WA ZIP 98052 <br /> CONTRACTOR PHONE:425-429-4240 CONTRACTOR EMAIL:Jules.mayer@wsfp.us <br /> CONTRACTOR LIC.#(REQUIRED):WESTESF906P1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 20553 <br /> PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-429-4240 <br /> Jules Mayer CONTACT EMAIL:jules.mayer@wsfp.us <br /> 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 <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 12/10/2019 E \q \c) Oi" <br /> awn /Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />