12906 19TH AVE SE IN N OUT PHO 2023-06-13

III 0 t ELECTRICAL PERMIT APPLIC ION 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 12906 BOTHELL-EVERETT HWY, SUITE B BUILDING AREA: 1242 sq ft PROJECT TYPE: El NEW CONSTRUCTION LI ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 2931 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: _ THE SCOPE OF THIS PROJECT IS TO ADD NOTIFICATION AND INITIATING DEVICES FOR THE PURPOSE OF TENANT IMPROVEMENT THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES-Select Scope: ❑ Service El Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 6 SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑ Thermostat Ti Audio ❑ Secure Access El 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: I✓I 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 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. CONTACT INFORMATION OWNER NAME: FRED MEYER STORES INC TENANT BUSINESS NAME(If Commercial): IN&OUT PHO OWNER MAILING ADDRESS: STREET 1014 VINE ST, FLOOR 7 c,,,, CINCINNATI STATE OH Z,P 45202 OWNER PHONE:N/A OWNER EMAIL:N/A CONTRACTOR NAME: SMITH FIRE SYSTEMS CONTRACTOR ADDRESS: STREET 1106 54TH AVE EAST CITY TACOMA STATE WA ZIP 98424 CONTRACTOR PHONE: 253-248-2051 CONTRACTOR EMAIL:RBENNETT@SMITHFIRE.COM CONTRACTOR LIC.#(REQUIRED): SMITHFS861 RS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 23577 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-248-2051 RACHEL BENNETT CONTACT EMAIL: RBENNETT@SMITHFIRE.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 Statetrac Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERM IT!#: ^/ RACHEL BENNETT 4128/22 `� l� l� ® O Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application