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EMI
<br /> 'LECTRICAL PERMIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> . ; PROJECT SITE I ORMATIO :::....';,in...... i ,
<br /> PROJECT ADDRESS: 1525 75th St SW, Everett, WA 98201 _BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT JMPROVMENT ❑REMODEL
<br /> BUILDING USE: ❑SFR Cl TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
<br /> u
<br /> ELE,CTRI. A.... I»M�i11GTlt N INPOR�I�T t .& lk�l $C lN ;1".i.0 O . ..O K
<br /> CONTRACT PRICE OF WORK: 3000.00 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WOkK: /
<br /> Replace 480v 3p 350aPNL H 1 H7). WO# 50001 Contact: Tim W. 206-406-4123
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope:❑ Service 0 Feeder ❑Circuits-#:42 ❑ Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System
<br /> ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and Installation approval.
<br /> El Other(List All):
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<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO 11 YES--See Below&Pg.2
<br /> n 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
<br /> 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 EYES-See Below&Pg.3
<br /> LiPursuant 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 /> a.... __.;''.` .. :,:. R ,..,.' 0ONTAC"I".:INFORMATIO.N.`.ARMAI,..= ';: xt r °„i. , F. ,°... . ...
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Comcast Everett Tech Ctr.
<br /> OWNER MAILING ADDRESS: STREET 1525 75th St SW
<br /> cry Everett STATE WA Zia 98201
<br /> ,
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ..... ...,. .....
<br /> CONTRACTOR NAME: Cochran Inc.
<br /> CONTRACTOR ADDRESS: STREET 12500 Aurora Ave N
<br /> CITY Seattle STATE WA ZIP 98133
<br /> CONTRACTOR PHONE:206'368-3197 ,CONTRACTOR EMAIL:twilliamson@cochrninc.com
<br /> CONTRACTOR LIC.#(REQUIRED):COCHRI'0e8JS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 11955a
<br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-368-3201
<br /> J eci n a Brown CONTACT EMAIL:bbrown@cochraninc.com
<br /> AGREEMENT:I hereby certify that l 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 or
<br /> 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
<br /> comply with the State Contractors Law 8.27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT#:
<br /> / 10.5-19 E n \ - (D"- g
<br /> Ow-erlAuthorized Agent ignature Date (Revised 1/11/2019 Page 1-Application
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