1135 CRAFTSMAN WAY PORT OF EVERETT OFFICE 2023-10-23

EirCTRICAL PERMIT APPL ►TION EVERETT CITY OF EVERETT PERMIT SERVICE 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov�+ I�www.everettwa.gov/permits `�. Nmmit ,lam r am` y # �� � PROJECT ADDRESS: 1135 Craftsman Way BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ., ..Yr,.,..--14I MI?, CONTRACT PRICE OF WORK:$ 500.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: install 2 wall sig n 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 El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ 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): install 2 wall signs h� -� _rr ��z R� .:�� s;�fy rrepc��_� ��°��-�t'. � , p � , �'� �� <N��r,, � �x��rr`�, � �� :"y: ' ,w, .,: .,`.. ,�''�.z i : V,,r v., ...e..-""�"'.,...Y �',r^ °:, .. fs, .'',FAODEIcQMPIJP�r,.*5:,''`"Sr'4 �,d'.•`.�'�r%,-s -`' " r' .er,t,+ ;:n,,rt:. .a-itft'.'`N.i- IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO Li 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: ENO EYES-See Below&Pg.3 ❑ 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. o 4 .. Pal4":ONTA RINEORM - .� '�' ». _ �Tr�� 't¢��.a,�..... ?" ''�.- � a„ ,.:, :.-_.�zr�r. .,.ds.', ..,„� � ..ram ��-<,.�-F�. ��.:� OWNER NAME: port of everett TENANT BUSINESS NAME(If Commercial): same OWNER MAILING ADDRESS: STREET site address CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: TubeArt b( SpJ S- /G CONTRACTOR ADDRESS: STREET 11715 SE 5th ST cry Bellevue STATE Wa ZIP 98005 CONTRACTOR PHONE: 206 679 8732 CONTRACTOR EMAIL: shawnb@tUbeart.COm CONTRACTOR LIC.#(REQUIRED): TUBEAD11 10NH CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 6667 PRIMARY CONTACT: DOWNER L1CONTRACTOR ❑OTHER(Please Specify) CONTACT NAMEBOwen CONTACT PHONE: 206 679 8732 CONTACT EMAIL: shawnb@tubeart.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 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 I 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. City of Everett Official Use Only PERMIT#: 9/16/2022 E p<v= O q- f 6 J- Owner Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application Sg9 00?