6300 MERRILL CREEK PKY WATERTECTONICS 2023-06-16

ACTRICAL PERMIT APPLICITION 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 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: 2 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): IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: L✓� NO LJ YES -- See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-466-900, 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: ✓ NO ❑YES -See Below & Pg. ❑ 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 Facie 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. OWNER NAME:WaterteCtonICS TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 6300 Merrill Creek Parkway Suite C-100 ,T,, Everett STATE WA Z,, 98203 1 (OWNER PHONE: 866-402-2298 1OWNER EMAIL: CONTRACTOR NAME: B&H Fire and Security, LLC CONTRACTOR ADDRESS: STREET PO Box 3711 _,,,, Arlington STATE WA Z,, 98223 ICONTRACTOR PHONE:425-244-1445 ICONTRACTOR EMAIL: Jeff@BNHFire.com I (CONTRACTOR LIC. #(REQUIRED): BHFIRHF842KW ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 055697 1 (PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR E] OTHER (Please Specify) I (CONTACT NAME: CONTACT PHONE:425-244-1445 Jeff Brossard ICONTACT EMAIL: Jeff@BNHFire.com 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/ 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 #: Jeff Brossard pa�ea202301.1714:4s3�50810 1/1 7/2022 I E /-- Owner/Authorized Agent Signature Date (Revised 41512022) Page 1-Application