3102 ROCKEFELLER AVE CANFIELD MADOW LAW GROUP 2022-11-28

0.ECTRICAL PERMIT APPLOATION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 wasH!NGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa_govI www.everettwa.gov!permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3102 Rockefeller Avenue BUILDING AREA: 3.857 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX I ADU ❑ MULTI-FAMILY-#OF UNITS: Q COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 30,000.00 ASSOCIATED BUILDING PERMIT#(it applicable): B1909-028 DESCRIBE SCOPE OF WORK: Tenant improvement involving of LED lighting, new low-voltage data wiring, and reworking receptacles. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? n NO ❑✓ YES-Select Scope: 7 Service ❑ Feeder ❑✓ Circuits-#: 15 n Complete Re-wire LOW VOLTAGE WORK? ❑ NO n YES-#of Devices:40 SELECT SCOPE(REQUIRED): ✓❑ Data ❑ Intercom i❑ Thermostat ❑ Audio ❑ Secure Access 7 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. 7 Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO El 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: RNO 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: Rockefeller Building LLC TENANT BUSINESS NAME(If Commercial): Canfield Madow Law Group OWNER MAILING ADDRESS: STREET 3732 94th PL NE c, Marysville STATE WA zip 98270-9111 OWNER PHONE:425.212.1825 OWNER EMAIL: CONTRACTOR NAME: Alta Electrical Inc CONTRACTOR ADDRESS: STREET PO BOX 6258 CITY Edmonds STATE WA ZIP 98026 CONTRACTOR PHONE:206.870.7641 CONTRACTOR EMAIL:chris@altaelectricaLcom CONTRACTOR LIC.#(REQUIRED):ALTAEEI823M4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Apr PRIMARY CONTACT: DOWNER L✓JCONTRACTOR LOTHER (Please Specify) CONTACT NAME: CONTACT PHONE:360.870.7641 Dan Johnson CONTACT EMAIL:Dan@altaelectrical.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 State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: - / 03201/ E2o~JI 020 Owner/Authorized Agent Signature D e (Revised 1/11/2019) Page 1-Application