10915 16TH AVE SE 2023-05-22 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 .^1ASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10915 16th Avenue S.E BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: install AES radio to monitor existing FACP 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? El NO ❑✓ YES-#of Devices: 1 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO El 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 EYES-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: Everett Housing Authority TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 11109 16th Avenue SE Everett STATE WA ZIP 98206 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Guardian Security Systems CONTRACTOR ADDRESS: STREET 1743 1st Avenue S. CITY Seattle STATE WA ZIP 98134 CONTRACTOR PHONE:206-622-6545 CONTRACTOR EMAIL:efisher@guardiansecurity.com CONTRACTOR LIC.#(REQUIRED):GUARDSS233K5 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): j 3 +lit'J PRIMARY CONTACT: DOWNER EICONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206 622 6545 Elizabeth Fisher CONTACT EMAIL:efisher©guardiansecurity.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 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 Elli"*Z"LaPeL— PERMIT#: 11/4/2022 F ! lJ 2. - I VI Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application