2828 COLBY AVE KIMLEY HORN 2025-04-16

ACTRICAL PERMIT APPLIATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 i (E) PermilServices@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2828 Colby Ave Everett, WA 98201 BUILDING AREA: scl ft PROJECT TYPE: ❑ NEW CONSTRUCTION [:]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: $ 7000 ASSOCIATED BUILDING PERMIT # (if applicable): M2210-090 DESCRIBE SCOPE OF WORK: Low Voltage: Install (4) t'stats and relocate (6) t'stats THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? LINO [I YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO 0 YES- # of Devices: t0 SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom IJ 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*`°Vy"� 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: ✓ NO ❑YES -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 NAMEJEC Holdings 84 LLC TENANT BUSINESS NAME (If Commercial): Klmley-Horn OWNER MAILING ADDRESS: STREET PO Box 5267 yin Everett STATE WA Z,P 98206 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ACCO Engineered Systems CONTRACTOR ADDRESS: STREET 5300 Denver Ave S „Y Seattle STATE WA Z,P 98108 CONTRACTOR PHONE: 2065930508 CONTRACTOR EMAIL: cferry@accoes.com CONTRACTOR LIC. #(REQUIRED): ACCOES1971Kw CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 37887 PRIMARY CONTACT: DOWNER ❑CONTRACTOR []OTHER (Please Specify) CONTACT NAME: Colleen Ferry CONTACT PHONE: 2065930508 CONTACT EMAIL: cferry@accoes.com „c,G y c uiy urdt t tvdva redu anu examined rots appitcauon and Know the same to de true and correct. All provisions oflaws 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/ 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. Cityof Everett Official Use Only PER #: Dly: C= signed by Colleen Ferry ^ �� l- Colleen FerryDNCeredScferry,CN=CsconFerryco 11/07/22 �� 57 E gineerad Systems, CN=Colleen Ferry Data: 2022 11.07 08:52:22-08'00' Owner/Authorized Agent Signature Date (Revised 41512022) Page 1-Application