10 SE EVERETT MALL WAY HASHTAG CANNABIS 2023-04-06

® ELECTRICAL PERMIT . -1]•N • V E R T T 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: b Se EVE.ReY7' MALL vJrNY EViS Q&77 9820E3 BUILDING AREA: sq ft PROJECT TYPE:AI NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WOR ` CONTRACT PRICE OF WORK:$ 64. ®® ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Hoot ye (1) /r 11-1-CimIN O WA. - 5/G, le..6"0i4/6 " E4 i "4&- (ANA)a (ars" ,4O xr sr/A/G PDw&L r ,VGA) C'P o,7 PONE B ' O7//E THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? X NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? sg 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): 516 A),S 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 LICENSUREO EYES-See Below&Pg. 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on uil ings 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: ES7VOLD >"UERE7T R.6AL f.f_C TENANT BUSINESS NAME(If Commercial): H4skIr46 4s$-/V4/4 j j OWNER MAILING ADDRESS: STREET 330Z Oys1GES AV G CITY AN GOR,7'ES STATE WA ZIP 7 82Z' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: M CAT N Noe76)W6S`r CONTRACTOR ADDRESS: STREET 27/0 /O i/7 4 ST cr.- 5- CITY JAKEWc-b STATE WA ZIP 99 I `/ CONTRACTOR PHONE: 253 1/95- 7pi I CONTRACTOR EMAIL: bbro„,,ne, he.A4-I►n0/' wasLcoM CONTRACTOR LIC.#(REQUIRED) 14EA'T1-}NT 0 13 L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253 £/c 5-70 c f SR IA/V 8Ro VOW CONTACT EMAIL: bbpoSf4,'1 ( hC'.q411 1)0t-Pi ujeS4- CD/!? 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 a permit does not presume to give authority to violate or cancel the provisions of any other state 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 6.9. 22 E 2U(O Sb orb Date (Revised 1/11/2019) Page 1-Application