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EOCTRICAL PERMIT APPLIiION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I(E)PermitServices@everettwa.gov I w,wv.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:3003 WEST CASINO ROAD 45-04 BLDG COL. AE-12 BUILDING AREA: 100k sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX Cl ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $15,000 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: PARTS AND SMARTS INSTALL,TERMINATIONS ONLY.ALL CONDUIT AND WIRE IS BY VELA ELECTRIC <br /> PARTS AND SMARTS INSTALL, TERMINATIONS ONLY. ALL CONDUIT AND WIRE IS BY VECA ELECTRIC <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? 0 NO DYES-Select Scope:❑Service ❑Feeder El Circuits-#: 0 Complete Re-wire <br /> LOW VOLTAGE WORK? El NO ❑YES-#of Devices:48 <br /> SELECT SCOPE(REQUIRED): 0 Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System <br /> ZFire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An <br /> additional Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 5NO a YES--See Below&Pg.2 <br /> ❑ 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 <br /> 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 <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ENO DES-See Below&Pg. <br /> ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale, or lease <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME:BOEING TENANT BUSINESS NAME(If Commercial):45-04 COL. AE-12 <br /> OWNER MAILING ADDRESS: STREET 3003 WEST CASINO ROAD <br /> CITY EVERETT STATE WA 7,P 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:ALEXANDER GOW FIRE EQUIOMENT CO. <br /> CONTRACTOR ADDRESS: STREET 1436 NW 53RD STREET <br /> CITY SEATTLE STATE WA ZIP 98107 <br /> CONTRACTOR PHONE:206-632-2810 CONTRACTOR EMAIL:kmullen©gowfire.com <br /> CONTRACTOR LIC.#(REQUIRED):ALEXAGF097NW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 050029 <br /> PRIMARY CONTACT: DOWNER EICONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-718-1009 <br /> KEVIN MULLEN CONTACT EMAIL: <br /> 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 + <br /> 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 <br /> or local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> el <br /> Jds- <br /> E "Do ; — " St) <br /> Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application <br />