3003 W CASINO RD BASE FILE 2023-10-26

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: 3003 W Casino Rd, Everett, WA 98204 BUILDING AREA: 4,320 scl 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: $ 69,760.91 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK:9 cat5e/install (3) 12 strand single mode fibers in 3 trailers 45-733,45-713,45-703 (43 cables in ea Install 129 cat5e/install (3) 12 strand single mode fibers in 3 trailers 45-733,45-713,45-703 (43 cables in each trailer) THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO DYES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO 0 YES- # of Devices: 129 SELECT SCOPE (REQUIRED): El 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: El NO LJ 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. E]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: Boeing TENANT BUSINESS NAME (If Commercial): Boeing OWNER MAILING ADDRESS: STREET 3003 W Casino RD CITY Everett STATE WA ZIP 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: NetCom, Inc CONTRACTOR ADDRESS: STREET 1632 Headland Drive c,T,, Fenton STATE M0 ZIP 63026 CONTRACTOR PHONE: 206-225-6212 CONTRACTOR EMAIL: gboroWSkl@netcom1989.com CONTRACTOR LIC. #(REQUIRED): 603 477 413 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 055129 PRIMARY CONTACT: [—]OWNER ❑CONTRACTOR E] OTHER (Please Specify) CONTACT NAME: Dustin MiddauCONTACTEMAIL:dmiddaugh@netcom1989.com CONTACT PHONE: 206-928-4205 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 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 #: 5-30-202: I E Owner/A thorized Agent Signature Date (Revised 41512022) Page 1-Application