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ELECTRICAL ^MIT & FIRE ALARM PIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 04Err <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:Building 40-25 Column L-1 1 306✓ I J C��/ gc, <br /> PROJECT TYPE: D NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL <br /> BUILDING AREA: sq ft <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $50,000 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? ✓❑ NO El YES-#OF DEVICES: <br /> IS THIS A FIRE ALARM PERMIT? ✓❑ NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) <br /> DESCRIPTION OF WORK & CODE COMPLIANCE <br /> DESCRIPTION OF WORK: Reconnect Existing Electrical Connections on Tool Shipped In Multiple Packages <br /> IS THIS PERMIT EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ❑YES--See Below&Pg.2 <br /> ❑ 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 <br /> 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: ENO EYES-See Below&Pg. 3 <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without <br /> the proper electrical licensing and certification,or exemption.By checking this box, I am stating that I have completed and signed the <br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> CONTACT INFORMATION <br /> OWNER NAME: Boeing TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3003 W Casino Rd <br /> cm, Everett STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:Valley Electric Co. of Mt. Vernon <br /> CONTRACTOR ADDRESS: STREET 1100 Merrill Creek Parkway <br /> city Everett STATE WA ziP 98203 <br /> CONTRACTOR PHONE:425-407-0832 CONTRACTOR EMAIL:permits@velectric.com <br /> CONTRACTOR LIC.#(REQUIRED):VALLEEC141 NA CITY OF EVERETT BUSINESS LIC.#(REQUIRED): j_S ZZS5 E3 <br /> PRIMARY CONTACT: E OWNER ✓❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-330-3401 <br /> Dave Mitchell CONTACT EMAIL:davem@velectric.com <br /> 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 <br /> 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 <br /> 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 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 1/10/2019 e 1 lO(—o7D <br /> Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application <br />