228 SW EVERETT MALL WAY GOODWILL 2023-07-28

0 ELECTRICAL PERMIT APPLI ATION CITY OF EVERETT PERMIT SERVICES Ey 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I w ww everettwa.gov/permits PROJECT SITE INFORMATION'° PROJECT ADDRESS: 228 SW Everett Mall Way, Everett, WA 98204 IBUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE 0 DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 3000 ASSOCIATED BUILDING PERMIT # (if applicable): _FA72o 6f —QD3 DESCRIBE SCOPE OF WORK: Replacing existing panel and adding monitor modules and an AES radio for communication. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES - Select Scope: ❑ Service ❑ Feeder U Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Devices: 10 SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom D Thermostat ❑ Audio �_] Secure Access ❑ Security System ✓❑ Fire Alarm - Installations under this permit only include electrical wiring rough -in of the system. An additional rFiir�re Alarm Permit is required for review of device location and installation approval. LJ Other (List AII): CODE COMPLIANCE _ IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: �✓1 NO L) YES See Below & Pg. 2 ❑ By checking this box, I am stating that 1 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: ZNO DYES -See Below & Pg. 3 a 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: Goodwill Industries TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 700 Dearborn Place S CITY Seattle ST;,T� WA z,, 98144 OWNER PHONE: 206-329-1000 OWNER EMAIL: CONTRACTOR NAME: Washington Alarm Inc CONTRACTOR ADDRESS: STREET 2030 Airport Way S CITY Seattle STATE WA Zip 98134 CONTRACTOR PHONE. 206-328-3288 CONTRACTOR EMAIL: permits@washingtonalarm.com CONTRACTOR LIC. #(REQUIRED): WASHIA1282C3 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 025389 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR []OTHER (Please Specify) CONTACT NAME: Treyve n Chin CONTACT PHONE: 206-436-5300 u� CONTACT EMAIL: permits@washingtonal<irm.com AGREEMEN7: I hereby certify that/ have read and examined this application and know the same to be true and correct. Ail 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 authcrity to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this properly m perform the work for which application is made and l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: E 9 e? ^% -6 Owner/Authorized Agent Signature e (Revised 1/1112019) Page 1-Application