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ELECTRICAL PERMIT APPLICATION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 5901 23RD DR W EVERETT WA 98203 1 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $ 4250 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> LOW VOLTAGE DETECTION AND CONTROLS FOR CLEAN AGENT FIRE SUPPRESSIONM SYSTEM <br /> IN 2 CONEX UNITS <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? s❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO ✓❑YES-#of Devices: 14 <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System <br /> s❑ 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: 71 NO Ll 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: ✓❑NO ❑YES-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: TENANT BUSINESS NAME(If Commercial): ZAP ENERGY <br /> OWNER MAILING ADDRESS: STREET 5901 23RD DRIVE W <br /> EVERETT STATE WA ZIp 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: SUPPRESSION SYSTEMS INC <br /> CONTRACTOR ADDRESS: STREET 3077 20TH ST E#B <br /> CITY FIFE STATE WA ZIP 98424 <br /> CONTRACTOR PHONE:253-926-3300 CONTRACTOR EMAIL:NINA@SUPPRESSION.COM <br /> CONTRACTOR LIC.#(REQUIRED):SUPPRS1995NS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 37502 <br /> PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:253-926-3300 <br /> NINA REEVES <br /> CONTACT EMAIL:NINA@SUPPRESSION.COM <br /> AGREEMENT:/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 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> Digitallysigned by NINA M REEVES PERMIT#: <br /> NINA M REEVES REEVES,o—SUPPRES1ON IDNC., NA ou eimail=NINA@SUPPRESSIONSCOMScSUS TEM5 E <br /> Date:2022.06.15 13:50:05-07'00' <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />