15 SW EVERETT MALL WAY NOVEL EYES 2023-10-24

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:15 SEW Everett Mall Way BUILDING AREA: 450 sq 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: $250.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Hook up new sign into existing power circuit Hook up new sign into existing ower circuit THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO [—]YES-Select Scope: ❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑r NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access 13 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: ✓ NO LJ YES--See Below&Pg. 2 F-1By 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 ES-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:ROsen Harbottle TENANT BUSINESS NAME(if Commercial):Novel Eye OWNER MAILING ADDRESS: STREET 1800 112th Ave NE, Suite 310 Bellevue STATE WA ZIP 98004 OWNER PHONE:425-289-2234 OWNER EMAIL:amyl@rosenharbottle.com CONTRACTOR NAME:New Image Creative Sign Inc. CONTRACTOR ADDRESS: ITREIT4549 125th Ave SE ,,r, Bellevue STATE WA Z,P 98006 CONTRACTOR PHONE:206-406-3437 CONTRACTOR EMAIL:Shari@newlmagecreative.com CONTRACTOR LIC.#(REQUIRED):NEWIMIC969DC CITY OF EVERETT BUSINESS LIC.#(REQUIRED):57624 PRIMARY CONTACT: ❑OWNER EICONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206_406_3437 Shari Rust CONTACT EMAIL:shari@newimagecreative.com AGREEMENT.I hereby certify that I 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 wilt be comp/e her 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 regulatin onstructio 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 ate Contract s Law 18.27 RCW and 296.200 WAC. Cit of Everett Official Use Only PERMIT#: 10/05/2022 E Owner/Authori ed Agent Signature Date (Revised 4/5/2022) Page 1-Application