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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASInNUToN (P) 425-257-8810 1 (E) Permlt6e"ceS@evereltwa.g0v I wvw.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 222 W Casino Rd, Everett, WA 98204 <br />BUILDING AREA: sq It <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION <br />❑✓ TENANT IMPROVMENT [—]REMODEL <br />BUILDING USE: ❑ SFR [:]TOWNHOUSE []DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK: $21,180 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIBE SCOPE OF WORK: HVAC Upgrades - Conduit & wiring for 3 AHU's and 5 Exhaust tans <br />HVAC Upgrades - Conduit & wiring for 3 AHU's and 5 Exhaust fans <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: ❑ Service <br />❑ <br />Feeder <br />❑ <br />Circuits-#: 3 <br />❑ <br />Complete Re -wire <br />LOW VOLTAGE WORK? 0 NO ❑ YES- # of Devices: <br />SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br />❑ Fire Alarm - Installations under this permit only include electrical wiring 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 AND/OR PERSONAL CARE FACILITIES: UNO ✓ YES --See Below & Pg. 2 <br />❑ By checking this box, I am stating that I have read and understand all of WAC 296.468.900, selected the specific reason on page <br />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 <br />See Page 2 require Plan Review. <br />ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: QNO —]YES -See Below & Pg. <br />❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br />See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br />CONTACT INFORMATION <br />OWNER NAME:MUkllteo School District 6 TENANT BUSINESS NAME If Commercial): Horizon Elementary <br />OWNER MAILING ADDRESS: STREET9401 Sharon or <br />E,N Everett STATE WA ...98204 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: Foy Group <br />CONTRACTOR ADDRESS: srnEET901 Powell Ave SW, Suite 100 <br />GnY Renton STATE WA ziP 98057 <br />CONTRACTOR PHONE: 206-937-6150 <br />CONTRACTOR EMAIL: ally.b@foygroup.net <br />CONTRACTOR LIC. #(REQUIRED): FOYGRGC863Lx <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 044569 <br />PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR E] OTHER (Please Specify) <br />CONTACT NAME: <br />Mark Davidyuk <br />CONTACT PHONE: 360-421-1417 <br />CONTACT EMAIL:mark.d@ioygroup.net <br />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 <br />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 <br />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 <br />comply wi(h the Sta Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br />PERMIT #: <br />09/07/2022 E ZC Flo — J <br />Ov*er/AuVhorized Agent S ature Date (Revised 41512022) Page 1-Application <br />