10121 EVERGREEN WAY JIMMY PEPPERS 2022-10-06

E . .CTRICAL PERMIT APPLICI'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.govlpermits 1 , • PROJECT ADDRESS: 10121 Evergreen Way (Suite 10) BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL CONTRACT PRICE OF WORK:$ 1600 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Installing a three Phase Circuit Reconfiguring a couple appliance circuits THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ✓❑YES-Select Scope: ❑ Service ❑ Feeder El Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El 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): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Li NO LI 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: ENO EYES-See Below&Pg.3 n 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. • OWNER NAME: JC Misko TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10121 Evergreen Way- Suite 10 clTv EVERETT STATE WA ZIP 98204 OWNER PHONE: 425-585-0028 OWNER EMAIL; jcmisko@jimmypeppersonline.com CONTRACTOR NAME: PARKER BROS ELECTRIC CONTRACTOR ADDRESS: STREET 13630 54TH DR NE cry MARYSVILLE STATE WA Zio 98271 CONTRACTOR PHONE:425-239-6319 CONTRACTOR EMAIL:GARY@PARKERBROSELECTRIC.COM CONTRACTOR LIC.#(REQUIRED): PARKEBE845NT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):56709 ✓ (Please _ .. . y) OFFICE AD ,. .. W ❑ PRIMARY CONTACT: ❑O NER CONTRACTOR OTHER SP ecif MIN CONTACT NAME: IATAI I E CONTACT PHONE:360-572-0108 CONTACT EMAIL: admin@parkerbroselectric.com AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. Al!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 �,,/QPERMIT#:0.A. 4.� 5/07/2019 EOwner/frthorized Agnature Date (Revised 1/11/2019) Page 1-Application