15 SW EVERETT MALL WAY NOVEL EYES 2024-06-12

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 { (E) PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 15 SW EVERETT MALL WAY BUILDING AREA: 2300 sq ft PROJECT TYPE: NEW CONSTRUCTION ❑ ADDITION ® TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY - # OF UNITS: Z COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $34,000.00 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: RECONFIGURE CIRCUITING FOR OPTOMETRY OFFICE RECONFIGURE CIRCUITING FOR OPTOMETRY OFFICE THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? Ell' NO ® YES - Select Scope: [:] Service ❑ Feeder [:1 Circuits-#: 1Q ElComplete Re-wire LOW VOLTAGE WORK? El NO a YES- # of Devices: 15 SELECT SCOPE (REQUIRED): Z Data ❑ Intercom [:] Thermostat ❑ Audio ❑ Secure Access ❑ Security System FIFire 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. El Other (List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO YES -- See Below & Pg. 2 By checking this box, l am stating that I have read and understand all of WAC 296-4613-900, 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: ZNO []YES -See Below & Pg. 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME:ROSEN BEL-KIRK ASSOC TENANT BUSINESS NAME (if Commercial): NOVEL EYES OWNER MAILING ADDRESS: STREET 1806 112TH AVE NE STE 310 c,�, BELLEVU E STATE WA zip 68004 OWNER PHONE: 425 289 2222 OWNER EMAIL: BRIANS@ROSENHARBOTTLE.COM CONTRACTOR NAME: SMOKEY POINT ELECTRIC CONTRACTOR ADDRESS: STREET3810 166TH PL NE STE 203 ClTy ARLINGTON STATE WA zip 98223 CONTRACTOR PHONE: 206 551 9738 CONTRACTOR EMAIL: SCOTTK@SMOKEYPOINTELECTRIC.COM CONTRACTOR LIC. #(REQUIRED): ECSMOKEPE933MB CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 46587 PRIMARY CONTACT: ❑OWNER CONTRACTOR F] OTHER (Please Specify} CONTACT NAME: SCOTT KOENIG CONTACT PHONE: 206 551 9738 CONTACT EMAIL.. SCOTTK@SMOKEYPOINTELECTRIC.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 I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Citz of Everett Official Use Only PERMIT #: d 8/1 /2022 Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application