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E•CTRICAL PERMIT APPLICIPIION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT;WA 98201 <br /> WASHINGTON (P)425-257-8810 I(E)PermitServices©everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:3003 WEST CASINO ROAD 40-30/31 BLDG COL. A13 BUILDING AREA: 100K 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:$2500 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK:PARTS AND SMARTS INSTALL,TERMINATIONS ONLY.ALL CONDUIT AND WIRE IS BY VECA ELECTRIC <br /> PARTS AND SMARTS INSTALL, TERMINATIONS ONLY. ALL CONDUIT AND WIRE IS BY VECA ELECTRIC <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑ NO DYES-Select Scope: ❑Service ❑Feeder ❑ Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices:20 <br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System <br /> ❑✓ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An <br /> additional 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 Li 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 <br /> 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 <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ENO OYES-See Below&Pg. <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):40-30 BLDG COL Al 3 <br /> OWNER MAILING ADDRESS: STREET 3003 WEST CASINO ROAD <br /> CITY <br /> 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 ZIR 98107 <br /> CONTRACTOR PHONE:206-632-2810 CONTRACTOR EMAIL:kmullen©gowfire.com <br /> CONTRACTOR LIC.#(REQUIRED):ALEXAGF097NW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 050029 <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-718-1009 <br /> KEV I N M U LL E N CONTACT EMAIL:kmullen@gowfire.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 authority to violate or cancel the provisions of any other state <br /> or 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 /> k � E 0Z0 <br /> Owner/Authorized Agent Signature Date (Revised 4/5/20221 Page 1-Application <br />