906 SE EVERETT MALL WAY COLUMBIA DEBT RECOVERY 2022-06-28

ELECTRICAL PERMIT APPLICATION % � CITY OF EVERETT PERMIT SERVICES 4 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 906 SE Everett Mall Way BUILDING AREA: 5,800 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL 21 ELECTRICAL APPLICATION IN, . MATION,tMEECRIrriVN # iNORK CONTRACT PRICE OF WORK: $ 10767.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Running 61 cat 6A cables to 61 locations for voice/data. THIS INSTALLATION INCLUDES THE FOLLOWING SCO . SELECT ALL THAT APPLY) 0LINE VOLTAGE WORK? ❑ NO YES-Sele ope: ✓❑SeIvice ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of De ices:61 / SELECT SCOPE(REQUIRED): ✓❑Data ❑ Intercom ❑The ostat ❑Audio ❑Secure Access ❑Security System ❑ Fire Alarm-Installations is 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 VO MPLOVNC1) ° .. . . . : . .. IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO [I 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 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. ... C OWNER NAME: PFLUEGER EVERETT HOLD' TENANT BUSINESS NAME(If Commercial): Columbia Debt Recovery OWNER MAILING ADDRESS: STREET 601 Union St, #5300 CITY Seattle STATE WA ZIP 98101 OWNER PHONE:DK OWNER EMAIL:DK CONTRACTOR NAME: Interface Technologies NW CONTRACTOR ADDRESS: sTREET6825 216th St SW, Suite E CITY Lynnwood STATE WA ZIP 98036 CONTRACTOR PHONE:425.977.2408 CONTRACTOR EMAIL:michaelr@interfacetechnw.com CONTRACTOR LIC.#(REQUIRED):INTERTN858DS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 040924 ma . ,,, PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:424-977.2408 Michael Russell CONTACT EMAIL:Michaelr@interfacetechnw.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 PERMIT#: Michael Russell — - 04.11.2019 E n014 - \ 0 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application