2510 BROADWAY 2022-08-10 - Laserfiche WebLink

! • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 41111 -i 3200 CEDAR STREET,EVERETT,WA 96201 (P)425-257-8810 I FAX 42S-257-8857 1(E)everetteps@everettwagov i www.everettwa.govtpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 2510 Broadway Everett,WA 98201 BUILDING AREA:2911 sq ft PROJECT TYPE; 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE 0 DUPLEX 0 ADU ❑MULTI-FAMILY-#OF UNITS: ✓�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? 0 NO JL�YES-Select Scope:0 Service 0 Feeder 0 Circuits-#:3 ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED); ❑Data 0 Intercom 0 Thermostat 0 Audio ❑Secure Access 0 Security System 0 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 0;YES--See Below&Pg.2 0 By checking this box,I am stating that I have read and understand all of WAG 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:ONO DYES-See Below&Pg.3 ❑ Pursuant to ROW 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:WIC Ventures TENANT BUSINESS NAME(If Commercial);The Wendy's Company OWNER MAILING ADDRESS: STREET 1820 E.Choctaw Drive cm, London STATE OH zip 43130 OWNER PHONE: OWNER EMAIL: David Antis CONTRACTOR NAME: System Solutions of WA CONTRACTOR ADDRESS: sTREETPO Box 5308 enr Lynnwood STATE WA za 98046 CONTRACTOR PHONE;425.249 2076 CONTRACTOR EMAIL;Contact©SyStemsolutionsta.Com CONTRACTOR LIC.#(REQUIRED):SYSTESW900PD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER [CONTRACTOR OOTHER(Please Specify) Electrical contractor ssw CONTACT NAME: CONTACT PHONE:425.249.2076 Nicole Heavin CONTACT EMAIL:nicoleh@systemsoiutionswa.com AGREEMENT.`Thereby certify that!have read and examined this application and know the same to be fore and correct All provisions of and ordinances governing!his type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authonty to violate orcanccel the provisions of any other state or local law regulating construction or the performance of construction: That lam authorized by the owner of this property to perform the work for which application is made and l comply with the State Contractors Law 18.27 RCWand 296.200WAC City of Everett Official Use Only PERMIT#: Nicole Heavin 2.26.19 E L t 04 -. co Owner/Authorized Agent.Signature Date (Revised 07/2019) Page 1-Application