5901 23RD DR W PROVIDENCE 2023-05-22

i.ECTRICAL PERMIT APPATION CITY OF EVERETT PERMIT SERVICLor EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 l(E)PermitServices@everettwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:5901 23rd Drive W, Suite 105 BUILDING AREA: 20569 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF-WORK CONTRACT PRICE OF WORK: $2500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Modify Existing Fire Alarm devices for tenant improvement. Modify Existing Fire Alarm devices for tenant improvement. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑r✓ NO OYES-Select Scope: ❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: r SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System 0 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 U 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:ENO OYES-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: TENANT BUSINESS NAME (If Commercial):HME-Everett OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:Fire Systems West, Inc. CONTRACTOR ADDRESS: sTREET2O6 Frontage Rd N, Suite-C CITY Pacific STATE WA ZIP 98407 CONTRACTOR PHONE:253-833-1248 CONTRACTOR EMAIL:Service@fireSyStemSWeSt.com CONTRACTOR LIC.#(REQUIRED):FIRESWI055LW CITY OF EVERETT BUSINESS LIC.#(REQUIRED):022919 PRIMARY CONTACT: DOWNER ECONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-951-6005 Matt Carl m a n CONTACT EMAIL:mattc@firesystemswest.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 re ulating 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 e State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only J PERMIT#: • 1/(// t E o8-c Q 6 Owner/Authorized Agent Signature (Revised 4/5/2022) Page 1-Application rA-a.xc,e —006