3900 BROADWAY ADMIN BLDG 2023-08-23

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:3900 Broadway BUILDING AREA: 100 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION Z TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $1600.00 ASSOCIATED BUILDING PERMIT#(if applicable):N/A DESCRIBE SCOPE OF WORK: Provide and install 4 Cat6 cables between telecom room 171 &2 2-port workstation locations. 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 Z YES-#of Devices: 4 SELECT SCOPE(REQUIRED): ❑✓ Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access In 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: Lj NO [✓j 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 NAME: Everett School District No. 2 TENANT BUSINESS NAME(If Commercial): Main Office OWNER MAILING ADDRESS: STREET 3900 Broadway ,,T, Everett STATE WA. Z,P 98201 OWNER PHONE: 425-385-4217 OWNER EMAIL:BKnutson@everettsd.org CONTRACTOR NAME: CTS - Cabling and Technology Services CONTRACTOR ADDRESS: STREET 2720 S. Ash St. CITY Tacoma STATE WA. Z,P 98409 CONTRACTOR PHONE:206-686-2000 CONTRACTOR EMAIL:customerservlce@CableCTS.Com CONTRACTOR LIC.#(REQUIRED):CTS**TS881 BK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 48173 PRIMARY CONTACT: [—]OWNER ❑✓ CONTRACTOR E]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-229-6347 Joe Weston CONTACT EMAIL: JoeW@cableCTS.com AGREEMENT:/hereby certify that 1 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 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: Unk Ta Go1- 09/26/2022 E Owner/Authorii,6d AgdvAt Signature Date (Revised 4/5/2022) Page 1-Application