7514 EVERGREEN WAY 2022-06-28 - Laserfiche WebLink

• 11111 '� ELECTRICAL PERMIT APPLICATION 04 —� CITY OF EVERETT PERMIT SERVICES ►' y-, 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-=881: I FAX 42545748857 I(E)everatteps©everettwa.gov I wuuw,everettwa,govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 7514 Evergreen.Way Everett WA 98203 BUILDING AREA:2665 sq ft PROJECT TYPE: Q NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: d COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 6000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Disconnect power to walk in cooler and hook up new walk in cooler. Replace fixtures in kitchen area. Hook up Kitchen equipment THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES Select Scope:0 Service 0 Feeder ❑Circuits-#:3 0 Complete Re-wire LOW VOLTAGE WORK? ❑NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED):'❑Data ❑Intercom ❑.Thermostat ❑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. ❑Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL.HEALTH AND/OR PERSONAL CARE:FACILITIES: J❑NO ❑YES--See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296.46E-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:ONO DYES-See Below&Pg.3 Pursuant to RCW 19.20.261,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 licensingicertification requirement. CONTACT INFORMATION OWNER NAME: Burger Management Systems of WA TENANT BUSINESS NAME(If Commercial):The Wendy's Company OWNER MAILING ADDRESS: STREET 1000 Oaksdale Ave SW Suite 115 cm, Renton STATE WA ZIP 98057 OWNER PHONE: OWNER EMAIL: David Antis CONTRACTOR NAME: System Solutions of WA CONTRACTOR ADDRESS: STREETRO Box 5308 cm,. Lynnwood STATE WA ZIP 98046 CONTRACTOR PHONE:425.249.2076 CONTRACTOR EMAIL:Contact SyStemsoluti0nSWac0m. CONTRACTOR LIC.#(REQUIRED):SYSTESW900PD CITY OF EVERETT BUSINESS L(C< (REQUIRED)s..._.._ PRIMARY CONTACT: DOWNER ❑CONTRACTOR ]OTHER(Please Specify) Electrical Contractor SSW CONTACT NAME: CONTACT PHONE:425.249.2076 Nicole Heavi CONTACT EMAILnicoteh@systemsaiutionswa.com' AGREEMENT:/hereby certlf,/that l have read and examined this application and know the same to be true and boned. 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!am authorized by the owner Of this property to perform the work for which application is made and! comply with the State Contractors Law 18.27 PC Wand 298.200 iYYAC. City of Everett Official Use Only PERMIT#: (''� Nicole Heavin 2.26.19 E k9 v4 00 s Owner/Authorized Agent Signature Date (Revised 1/1r20 91 Page 1-Application