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4677 ELCTRICAL PERMIT APPLICCION <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 /> PROJECT SITE INFORMATION • <br /> PROJECT ADDRESS: 1 1 1 7 Ttereve Dr, Everett BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ✓❑MULTI-FAMILY-#OF UNITS:4 ❑COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 1300 ASSOCIATED BUILDING PERMIT#(if applicable): -F02.I11- 00-1 <br /> DESCRIBE SCOPE OF WORK: <br /> Replacing Existing fire panel with new fire panel. Existing devices to remain the same. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data ❑ Intercom ❑Thermostat ❑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 /> ❑Other(List All): <br /> • CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO CI YES—See Below&Pg.2 <br /> I I 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: ©NO 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 <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: Don & Traci Riddle TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12311 38th Dr SE WA <br /> CITY Y Everett STATE Zip 98203 <br /> OWNER PHONE:206-206-7827 OWNER EMAIL: <br /> CONTRACTOR NAME: Washington Alarm <br /> CONTRACTOR ADDRESS: STREET 2030 Airport Way S <br /> CITY Seattle STATE WA ZIP 98134 <br /> CONTRACTOR PHONE:(206)328-1800 CONTRACTOR EMAIL:Permits@washingtonalarm.com <br /> CONTRACTOR LIC.#(REQUIRED):WASHIA1282C3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):025389 <br /> PRIMARY CONTACT: DOWNER ['CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-436-5300 <br /> Treyve n Chin CONTACT EMAIL:Permits@washingtonalarm.com <br /> 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 <br /> 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 <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 /> PERMIT#: <br /> 1 lL /3/2 E21 1 \ - o b <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />