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ums ECTRICAL PERMIT APPL OATION <br /> EVERETT 32 CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I wdvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS; 3003 WEST CASINO ROAD 13U3LDira:v AREA: 100K <br /> Sy ' <br /> 'PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION I✓I TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: u COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 9500.00 ASSOCIATED BUILDING PERMIT#(if applicable): 'q 0 "1/) <br /> !DESCRIBE SCOPE OF WORK: <br /> !EXTEND EXISTING FIRE ALARM TO COVER THREE NEW BLDGS. THE 45-997 /45-998 / 45-999 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: Service ❑ Feeder <br /> ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices:29 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat u Audio El Secure Access ❑ Security System <br /> ✓❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> 7 Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO I V 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: 'AND LIYES-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 <br /> without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the 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 45-02 BLDG. D-11 FIRST FLOOR <br /> CITY EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ALEXANDER GOW FIRE EQUIPMENT CO. <br /> CONTRACTOR ADDRESS: STREET 1436 NW 53RD STREET <br /> CITY SEATTLE STATE WA zp 98107 <br /> CONTRACTOR PHONE:206-632-2810 CONTRACTOR EMAIL:kmullen@govvfire.com <br /> CONTRACTOR LIC.#(REQUIRED):ALEXAGF097NW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 050029 <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-718-1009 <br /> KEVIN MULLEN CONTACT EMAIL: <br /> kmullen@gowflre.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 governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authonty to violate or cancel the provisions of any other state or <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> bPERMlT#: <br /> 6/24/2019 ` I ' J !Y <br /> OwnerlAuthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />