318 SE EVERETT MALL WAY MERLES AUTO 2023-04-20

EVERETT WASHINGTON ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwamov I www.everethva.onv/nArmltc PROJECT ADDRESS: G( a V IBUILDING AREA: 3 C EO sq Ift PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION TENANT IMPROVMENT El REMODEL IV S 16 J� BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: COMMERCIAL CONTRACT PRICE OF WORK: $ If 00 — ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Z Vl�� ((�y f 3 _ i ( 196)(- S� nr, THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO YES- # of Devices: SELECT SCOPE (REQUIRED): ElData X ❑ 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 ANDIOR PERSONAL CARE FACILITIES: JK NO YES -- See Below & Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-4613•90A, 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 Revlew. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO YES -See Below & Pg. 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on uildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that 1 have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this iicensingloertif!cation requirement. OWNER NAME: h TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ztP I�CJ�✓ OWNER PHONE: �� — a r7 � -~ 969 OWNER EMAIL: n G`tk 6)CI. C lean n a, C o rn CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 1 (7 CITY! e ,^ STATE Gv ZIP CONTRACTOR PHONE: � % % CONTRACTOR EMAIL: I G jt-( 1 V f CONTRACTOR LIC. #{REQUIRED}: ' �� CITY OF EVERETT BUSINESS LIC. #(REQUIRED):0522) G? PRIMARY CONTACT: DOWNER ❑CONTRACTOR OTHER (Please Specify) 1 (2 f CONTACT NAME: CONTACT PHONE: L' � --- Gl rJ ,_ (92_3& lit, a 1') type of worts will be completed whether specified herein or TACT EMAIL: S1 ris appitcadon ana Know the some lobe true and correct. All provisions of laws and ordinances Tha orantinr7 of a narmit ff we nni nrne,.mn ..�,...,..�.w.o w a:ry vwc+ siaev w locallaw regu acing construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and t comply with the State Contractors Law 16.27 RCW and 296.200 WAG, City of Everett Official Use Only PERMIT #: 22o2- DS� nerlAuthorized Agent Signature Date (Revised 1/1112019) Page 1-Appllcatlon