4231 RUCKER AVE 2022-07-27 - Laserfiche WebLink

OLECTRICAL PERMIT APPL ATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 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: 4231 Rucker Ave. BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 11 ADDITION 11 TENANT IMPROVMENT ❑ REMODEL f� BUILDING USE: El SFR El TOWNHOUSE El DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Remove (2) existing 76 logos from gas station canopy THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECTALL THAT APPLY) LINE VOLTAGE'WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: n'Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO ❑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: ✓❑NO ❑YES--See Below&Pg.2 1 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 u 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. r-;� ARE YOU ANLI 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: Thinh & Phuong Bui TENANT BUSINESS NAME(If Commercial): Rucker Food Mart OWNER MAILING ADDRESS: STREET 4231 Rucker Ave. c,n Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Phoenix Sign Company CONTRACTOR ADDRESS: STREET 16 Horizon Ln. CITY Aberdeen STATE WA ,,P 98520 CONTRACTOR PHONE:360-532-1111 CONTRACTOR EMAIL:shari.phoenixsign@gmaiLcom CONTRACTOR LIC.#(REQUIRED):PHOENSC923CG CITY OF EVERETT BUSINESS LIC.#(REQUIR D):51469 PRIMARY CONTACT: DOWNER DCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-532-1111 Shari Heiberg CONTACT EMAIL:shari.phoenixsign@gmail.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 1 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#: [oh ICI • E Ow /Authorized Agent Sig re D (Revised 1/11/2019) Page 1-Application