4027 4TH ST SE 2022-05-24 - Laserfiche WebLink

11111 • ELECTRICAL 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 l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4027 4th St. SE BUILDING AREA: 20000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE El DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8�,DESCRIPTION,OF-WORK;,: CONTRACT PRICE OF WORK:$ 50000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Annual Electrical Blank Permit-Everett Water Pollution Control Facility Perform repairs, general upgrades as needed, maintenance THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ✓❑YES-Select Scope:❑✓ Service Q Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO ✓❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom El Thermostat ❑Audio El 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):Electrical Maintenance,like in kind replacements 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. EYES ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO ❑✓YES-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: City of Everett TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3200 Cedar St. CITY Everett STATE WA zip 98201 OWNER PHONE:425-257-8220 OWNER EMAIL:kchristiansen@everettwa.gov' CONTRACTOR NAME: City of Everett CONTRACTOR ADDRESS: STREET 3200 Cedar St. CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE:425-257-8220 CONTRACTOR EMAIL:kchristiansen@everettwa.gov CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-309-0470 Ken Christiansen CONTACT EMAIL:kchristiansen@everettwa.gov 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 1 comply with the State C tractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 3/1/2021 E z l 0 3' 151 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application