4027 4TH ST SE 2025-05-15 - Laserfiche WebLink

�i 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) everelteps@everetlwa.gov I www,everettwa,gov)permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4027 4th St. SE BUILDING AREA: 20000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATIONINFORMATION &'DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 50000 IASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Annual Electrical Blanket Permit -Everett Water Pollution Control Facility Perform repairs, general upgrades as needed, maintenance THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: PI Service i] Feeder ❑✓ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ 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): Electrical maintenance, like and kind replacment CODE iICOMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO D YES -- See Below & Pg, 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 29646B-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: ONO ✓ YES -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: City Of Everett TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 3200 Cedar St on,, Everett STATE WA z,P 98201 OWNER PHONE:425-257-8220 1OWNER EMAIL: kchristiansen@everettwa.gov CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): I CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑✓ OWNER ❑CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Ken Christiansen CONTACT PHONE:425-309-0470 CONTACT EMAIL: kchristiansen@everettwa.gov 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 permit does not presume to give authority to violate or cancel the provisions ofany other state or local law regulating construction or the performance of construction. That Ian) authorized by the owner of this property to perform the work for which application is made and 1 comply with the State are ors Law 18.27 RCW and 296.200WAC. City of Everett Official Use Only / PERMIT #: 3/14/2022 E �Ze_' D'j ` (Revised 111112019) Page 1-Application