120 W CASINO RD 26 D PARK 120 APTS 2022-07-29

I 1111111111 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 l(E)everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SITE 1NPORMATION :.: =_.. � • ; PROJECT ADDRESS: 26-D, 120 W Casino Road, Everett 98204 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ✓❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTIONTOF-�EWORK,,, CONTRACT PRICE OF WORK:$ 2180 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Modify 3 circuits, move a sub-panel, move an existing outside light circuit to main panel THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ✓❑YES-Select Scope: ❑ Service 0 Feeder 0 Circuits-#:3 ❑ 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 oBfy tchhs cakpinp itchaitsi obo x(,s Ie ae mn etxat tiag teh)a,tA I ND veP raena Rd eaew u insd NOsT nredalil roefd WbeAcCa u2s9e6-I 4m6eBe0a0ll,osf etlheec ftoeldlo wthien gs se ifsiec rtieoanss otnh aot nd op angoe 2 See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: O DYES-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: TENANT BUSINESS NAME(If Commercial): Park 120 Apartments OWNER MAILING ADDRESS: STREET 120W Casino Road cin Everett STATE WA ZIP 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Active Engineering CONTRACTOR ADDRESS: sTREET6605 200th ST SW CITY Everett STATE WA ZIP 98036 CONTRACTOR PHONE:425-776-8119 CONTRACTOR EMAIL:acoberly@activeengineering.net CONTRACTOR LIC.#(REQUIRED):Active*088ms CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 026248 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-683-0984 Wayne Sandall CONTACT EMAIL:wsandall@activeengineering.net 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#: 12_0 E 2C -- O�`�Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page