11000 16TH AVE SE 2023-05-22 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINOTON (P)425-257-8810 I(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 1000 16th Ave SE BUILDING AREA: 5000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑✓ MULTI-FAMILY-#OF UNITS:8 ❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $1500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Fire Alarm Control Panel Replacement - Like For Like Fire Alarm Control Panel Replacement - Like For Like THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO OYES-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 ❑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:LINO FIYES-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 Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME:Breckenridge Apartment Homes TENANT BUSINESS NAME(If Commercial): Breckenridge Apt Homes OWNER MAILING ADDRESS: STREET 11000 16th Ave SE cm, Everett STATE Wa ZIP 98208 OWNER PHONE:425.256.4262 OWNER EMAIL:breckenridgedir@weidner.com CONTRACTOR NAME:Fire Protection, Inc CONTRACTOR ADDRESS: STREET PO BOX 12642 ,IT., Bothell STATE Wa ZIP 98082 CONTRACTOR PHONE:425.290.9600 CONTRACTOR EMAIL:daviS@fpiseattle.com CONTRACTOR LIC.#(REQUIRED):FIREPI*021 ML CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 038814 PRIMARY CONTACT: DOWNER CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.290.9600 David Mow CONTACT EMAIL:david@fpiseattle.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 PERMIT#: Digitally signed by DAVID MOW DAVID MOW PROTEC I DI@FPI EATTLE COMRE 11/3 0/22 E -- Z, I Z� _ C 3 3 ernail=DADate 2022.11.30 12:2829-08'00' Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application