1000 SE EVERETT MALL WAY US PROBATION COURT OFFICE 2023-05-19

NEI ECTRICAL PERMIT 3200APPLICATION EVERETTCITY OF EVERETT PERMIT SERVICE CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits ,;JECT S �I II19lTIO ,,! PROJECT ADDRESS: 1000 SE EVERETT MALL WAY STE 350 BUILDING AREA: 3800 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 11 ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE El DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELIEWASAL APPLICATION <ATION & DESCRIPTIO ; �` ::.WORK CONTRACT PRICE OF WORK: $ 10,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD FIRE ALARM BOOSTER PANEL, ADD 19) AUDIO/VISUAL FIRE ALARM NOTIFICATION DEVICES, AND ADD 10) FIRE ALARM INITIATING DEVICES TO EXISITNG FA SYSTEM. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO El YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: E Complete Re-wire LOW VOLTAGE WORK? El NO n YES-#of Devices:30 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio El Secure Access El 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: ❑✓ NO FIVES-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 E OWNER NAME: Pfluefer-Everett Holdings LLC TENANT BUSINESS NAME(If Commercial): US Probation OWNER MAILING ADDRESS: STREET 1000 SE Everett Mall Way CITY Everett STATE WA ziP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Western States Fire Protection CONTRACTOR ADDRESS: STREET 14690 NE 95th ST#101 CITY Redmond STATE WA zp 98052 CONTRACTOR PHONE:425-881-0100 CONTRACTOR EMAIL:jules.mayer@wsfp.us CONTRACTOR LIC.#(REQUIRED):WESTESF906P1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 20553 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-429-4240 Jules Mayer CONTACT EMAIL:jules.mayer@wsfp.us 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 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#: 04/01/2021 t O ,-0-w r/Authorized Agent Signature Date 1 ( (Revised 1/11/2019) Page 1-Application