8402 EVERGREEN WAY CHEVRON 2024-04-02

E ECTRICAL PERMIT APPLICTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX425-257-8857 I (E)everetteps@everettwa.govI www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 8402 Evergreen Way, Everett WA 98208 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT 7 REMODEL BUILDING IJSE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 1,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: (P1 - Pole Sign): Wire new LED gas price faces to existing electrical circuit. (P2 - Pole Sign): Wire new LED gas price faces to existing electrical circuit. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:2 ❑ Complete Re-wire 7-'F-0-to VVOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 12v-60w LED --5,E, ECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑Audio El Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑✓ Other(List All):2 @ 20amp Circuits(LED ILLUMINATION) CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO ❑YES--See Below&Pg. 2 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 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑✓ NO EYES-See Below& Pg. 3 n Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and igned the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: AMANS Ill LLC TENANT BUSINESS NAME(If Commercial): Casino Chevron OWNER MAILING ADDRESS: STREET 8402 Evergreen Way c,,, Everett STATE WA ZIP 98208 OWNER PHONE:425-917-2109 OWNER EMAIL:steven@insigniasign.com CONTRACTOR NAME: Insignia Sign & Re-Imaging CONTRACTOR ADDRESS: STREET 325 Burnett Ave N CITY Renton STATE WA ZIP 98057 -CONE TOR PHONE:425-917-2109 CONTRACTOR EMAIL:Steven@inslgniasign.COm CCSOT_RAC.T.QR LIC.#(REQUIRED): INSIGSR819L8 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 63283 PRIMARY CONTACT: DOWNER ECONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425 917-2109 Steven Thomson CONTACT EMAIL:steven@insigniasign.com 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 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 local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#:/� Steven Thomson 04/22/22 E ✓w�. Y�� Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application