3003 W CASINO RD BLDG 40-22 2023-12-06

"P(10,Y—/71 OLECTRICAL PERMIT APPLIIATION CITY OF EVERETT PERMIT SERVICES t 20 7 ZIDA d I 0 C,'3S. L 3200 CEDAR STREET,EVERETT,WA 98201 I C j (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PR'OJLGT SITE 1NFORMAY10. ; PROJECT ADDRESS: r ` I d c k- LjU' G.Z BUILDING AREA: • sq ft PROJECT TYPE: ❑ NEW CONSTRUC ON El ADDITION El TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: El COMMERCIAL ,r, ELECTRICAL APPLICATION".INFORMATION &DESCRIPTION OE WORK CONTRACT PRICE OF WORK:$ ir6Zi C) ASSOCIATED BUILDING PERMIT#(if applicable): • �1 ,4`'� DESCRIBE SCOPE OF WORK: 1NASILIAUS 4yi 1 n ,leiSOYS -Cov bC(;S1(�V1 Gt,�Sd bv) d S ..21 , 22i ZS) Zy THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT,�( ALL THAT APPLY) LINE VOLTAGE WORK? r❑� NO Lis rJ-Select Scope: Service El Feeder CICircuits•#: ❑Complete Re-wire LOW VOLTAGE WORK? . I:�N/Q ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑Intercom El 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): CODE COMPLIANCE; "iS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: MO ❑YES--See Below&Pg.2 By checking this box, I are 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: li iO OYES-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. • ON � N` A710 OWNER NAME: TENANT BUSINESS NAME(If Commercial): Boeing OWNER MAILING ADDRESS: STREET PO Box 3707 arr Seattle STATE WA ZIP 98124-2207 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: General Construction Company �� ~��..w W �� l��rc�mm�^�m,�� • CONTRACTOR ADDRESS: STREET PO Box 46 ;: CITY Mukilteo STATE WA Zp 98204 CONTRACTOR PHONE:425-294.6944 CONTRACTOR EMAIL:Bridgett.Burns@kiewit.com CONTRACTOR LIC.#(REQUIRED):GENERCC984OZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 040599 PRIMARY CONTACT: DOWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-730-6546 Dennis Crow CONTACT EMAIL:Dennis.crow@kiewit.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 r comply with the Stale Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: (02c l9 E 9 of - 2� Owner uthorize gent Sign e Date (Revised 1/11/201y' � Page 1-Application It. •