1203 SE EVERETT MALL WAY BASE FILE 2023-05-15

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 i (E) PermitServices@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:'1203 SE Everett Mall Way unit M BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION Z TENANT IMPROVMENT [:]REMODEL BUILDING USE: ❑ SFR []TOWNHOUSE [:]DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL ELECTRICALAPPLICATION INFORMATION &`DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $750 ASSOCIATED BUILDING PERMIT # (if applicable):M2210-040 DESCRIBE SCOPE OF WORK: Electrical portion of like for like replacement of rooftop package unit (permit M2210-040) Electrical portion of like for like replacement of rooftop package unit (permit M2210.040) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO R1YES -Select Scope: ❑ Service []Feeder Q Circuits-#: ' []Complete Re -wire LOW VOLTAGE WORK? El NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO 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: QNO DES -See Below & Pg. ❑ 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:Evel-ett Mall 11, LLC TENANT BUSINESS NAME (if Commercial): VACANT OWNER MAILING ADDRESS: ITREIT1221 2nd Ave N Kent STATE WA ...98032 OWNER PHONE:206-775-6414 1OWNER EMAIL:khamill@hermanSOn.COm CONTRACTOR NAME:HermanSOn Company CONTRACTOR ADDRESS: 111EET1221 2nd Ave N CITYKent STATE WA zip 98032 CONTRACTOR PHONE:206-775-6414 CONTRACTOR EMAIL:khamill@hermanSQn.COm CONTRACTOR LIC. #(REQUIRED);HERMACL995DK CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 37262 PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Kaytlyn Hamill CONTACT PHONE:206-775-6414 CONTACT EMAIL: khamill@hermanson.com AGREEMENT: I hereby certify that 1 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 permit does not presume to give aulhodly to violate or cancel Ilia provisions of any other state or local law regulating construction or the performance of construction. That tam authorized by Ilia 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 #: 11/01/2022 2211-001 Kaytlyn Hamill ��t .„"`. �_;:w. ��_ ;°ate �� o�� Owner/Authorized Agent Signature Dale (Revised 41512022) Page 1-Application