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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />3200 CEDAR STREET, EVERETT, WA 9e201 <br />WASHINGTON <br />(F) 425-25788101(E) Pernaldrvlresidevi we govI vaim evervanal govIdennlle <br />PROJECT SITE INFORMATION <br />PROJECTADDRESS: 7920 Evergreen way, EverettWA I BUILDING AREA: 4000 si <br />PROJECT TYPE: O NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT 0 REMODEL <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADD ❑ MULTI -FAMILY -p OF UNITS:_ ® COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION A DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORKS ASSOCIATED BUILDING PERMIT p lit applicable)' <br />DESCRIBE SCOPE OF WORK: Run approx 60 low voltage wires from network rack to pos <br />Equipment. <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: SELECT ALL THAT APPLY) <br />LINE W)LTAGE WORK? ONO O YES -Select Scot : O Service O Feetler O CircuiQ4: O Complete Rewire <br />LOW VOLTAGE WORK? ❑ NO ®YESkMDeviou: 30 aDProx <br />SELECT SCOPE (REQUIRED): ® Data ❑ Intercpm O Thermostat ❑ Audio ❑ SEare Access ❑ Sacunty System <br />❑ Fire Alarm - Installations undertbls permit only include electrical wrong rough -in of the system. An <br />additional Fire Alarm Permit Is required for review of device location and installation approval. <br />❑ Other (List All): <br />CODE COMPLIANCE <br />IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: 0 NO U YES - Sae Below 8 Phi.2 <br />❑ By checking this box, I am slating that I have read and understand all of WAS 29646E-9N, selected the specific reason on page <br />2 of this application (a" next page), AND Plan Review is NOT required because I meet all of the following sub sections Mat do not <br />Sae Pege2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO DYES -SBB BBIGw & Pi <br />❑ Pursuant to RCW 19.28.261, property Owners and leaseholders cannot Worm electrical work on buildings he rent, sale, or lease <br />without the proper electrical licensing and certifcation, or exemption. By checking this box, I am Sun ng Mat I have completed and <br />See Pages signed the AFFIDAVIT on page 3 Of this application to receive exemption from this licensinglcertifmation requirement. <br />CONTACT INFORMATION <br />OWNERNAME: McDonald's TENANT BUSINESS NAME tit Commercial: <br />OWNER MAILING ADDRESS: sm=7920 Evergreen way <br />r, Everett STATEWA zip 98203 <br />OWNERPHONE: OWNER EMAIL: <br />CONTRACTOR NAME: Scott Installs LLC <br />CONTRACTOR ADDRESS: <br />ay Kirkland STATE WA zip 98034 <br />CONTRACTOR PHONE:42.5-.501-6067 <br />CONTRACTOREMAIL: SWeelbor eOahoo.com <br />CONTRACTORLIGtlREQUIREDg SCOBI Hi4 1 ICITY OF EVERETT BUSINESS LIC REQUIRED): 62456 <br />PRIMARY CONTACT: ®OWNER ❑CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 426'501-6067 <br />Scott Weelbor CONTACT EMAIL: SWeelbor @ ahoo.com <br />6,9,22 <br />L <br />wnenAuthori. Agent Sammure Ilele <br />al <br />