10521 19TH AVE SE NEW LEAF PHO 2023-06-09

® ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)426.267-8810 1 FAX 425-257-8857 1(1-)everetteps@everettwa.gov I www.overeltm.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10521 19th Ave SE Suite 100 1BUILDING AREA: 1600 sq ft PROJECT TYPE: R)NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: O COMMERCIAL ELECTRICAL APPLICATION;INFORMATION & OESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 9850.00 ASSOCIATED BUILDING PERMIT#(if applicable): B2102-035 DESCRIBE SCOPE OF WORK: for Restaurant-new leaf pho 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: SELECT SCOPE(REQUIRED): ❑Data ❑ Intercom Q✓ 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: EINO YES—See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 29646B-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 Sea Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO ❑YES-See Below&Pg.3 Q 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. CONTACTINFORMATION OWNER NAME: kin wa Chan TENANT BUSINESS NAME If Commercial): New Leaf Pho OWNER MAILING ADDRESS: MEET 1432 173Rd SW ,,, Lynnwood STATE WA ,98037 OWNER PHONE:3609900836 1OWNER EMAIL:bluewhalechemical@gmail.com CONTRACTOR NAME: kin wa Chan CONTRACTOR ADDRESS: IIEII1432 173rd SW crrr Lynnwood STATE WA z,,98037 CONTRACTOR PHONE:3609900836 CONTRACTOR EMAIL:bluewhalechemical@gmail.COm CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):62990 PRIMARY CONTACT: ✓❑OWNER ❑✓. CONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:3609900836 kin wa ehan CONTACTEMAtL:bluewhalechemical@gmail.com AGREEMENT:I hereby certify that f 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 spectiled 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 1 am authorized by the owner of this property to perform the work forwhich application is made and I comply with the State Contractors taw 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT M E Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application