3201 SMITH AVE BEZOS ACADEMY 2024-08-07

ElICTRICAL PERMIT APPLIIITION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 wASHrNaTbN (P)425-257-8810 (E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:3201 SMITH AVE BUILDING AREA: -300o sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:.$100,000 ASSOCIATED BUILDING PERMIT#(if applicable):B22025-053 DESCRIBE SCOPE OF WORK: TENANT IMPROVEMENT OF EXISTING EVERETT STATION TENANT IMPROVEMENT OF EXISTING EVERETT STATION THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑J YES-Select Scope:El Service El Feeder ❑✓ Circuits-#:20 ❑Complete Re-wire LOW VOLTAGE WORK? El NO DYES-#of Devices:50 SELECT SCOPE(REQUIRED): El Data El Intercom ❑Thermostat El Audio ❑✓ Secure Access ❑Security System ElFire 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 a 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:ENO DYES-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:N/A TENANT BUSINESS NAME(If Commercial): Bezos Academy OWNER MAILING ADDRESS: STREET P.O. Box 1042 cIn Mercer Island STATE WA Z,P 98040 OWNER PHONE: OWNER EMAIL:zoe.burke@bezosacademy.org CONTRACTOR NAME:TB (,Yv.Q CONTRACTOR ADDRESS: STREET TBD STATE TBD ,,,TBD CONTRACTOR PHONE:TBD CONTRACTOR EMAIL:TBD CONTRACTOR LIC.#(REQUIRED): \j 51J )CITY OF EVERETT BUSINESS LIC.#(REQUIRED(, -� � ) PRIMARY CONTACT: DOWNER DCONTRACTOR BOTHER(Please Specify) Electrical Engineer /I CONTACT NAME: ,, CONTACT PHONE:206-436-0402 Taylor VanderKIey CONTACT EMAIL:taylor.vanderkley@hargis.biz 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: (lam Digitally signed by Taylor V and erKley 06/01/22 E 2`O T O Date:2022.06.01 08:30:27-07'00' Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application ; �