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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:3003 W Casino Rd, Everett, WA 98204 (40-YD Site) BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $215,000 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Provide new 400A panels at two stalls that feeds the power stands, disconnects & receptacles -Seq. Job#202650 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope:❑Service ❑✓ Feeder ❑✓ Circuits-#:2 []Complete Re-wire <br /> LOW VOLTAGE WORK? El NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑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 <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: Ld NO LJ YES--See Below&Pg. 2 <br /> By checking this box, I am stating that I have read and understand all of WAC 296-4613-900,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: ✓ NO ❑YES-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:The Boeing Company TENANT BUSINESS NAME(If Commercial): The Boeing Company <br /> OWNER MAILING ADDRESS: sTREET PO Box 3703 MC IF-41 <br /> ,,n Seattle STATE WA Z,P 98124 <br /> OWNER PHONE:206.766.2907 1OWNER EMAIL: n/a <br /> CONTRACTOR NAME: SegUOyah Electric LLC <br /> CONTRACTOR ADDRESS: STREET 15135 NE 92nd Street <br /> , Redmond STATE WA Z,P98052 <br /> CONTRACTOR PHONE:425.814.6000 CONTRACTOR EMAIL:jj•hjorten@SegUOyah.COm <br /> CONTRACTOR LIC.#(REQUIRED):SEQUOEL977S9 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0&45$ <br /> PRIMARY CONTACT: ❑OWNER OCONTRACTOR []OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206.817.8442 /alt. Angela Hocking 425.766.1030 (applicant) <br /> JJ Hjorten, Project Manager CONTACT EMAIL:jj.hjorten@sequoyah.com/alt.angela.hocking@sequoyah.com(applicant) <br /> AGREEMENT.'I hereby certify that/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/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 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> PERMIT#: <br /> 6/16/2023 E <br /> Owner/othorized Age6t Signature Date (Revised 4/5/2022) Page 1-Application <br />