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• <br /> r":":‘ <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettops@everettwa.gov I wwweverettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3003 WEST CASINO ROAD 40-32 BLDG COL BUILDING AREA: 100K <br /> PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION C✓a TENANT IMPROVMENT IDREMODEL sq tt <br /> BUILDING USE: El SFR D TOWNHOUSE ❑DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: t-� <br /> Ly1 COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 19000 jASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> REPLACE SPRINKLER MONITORING PANEL <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? Q NO E YES-Select Scope:CI Service <br /> CI Feeder El Circuits-#; ❑Complete Re-wire <br /> LOW VOLTAGE WORK? El NO CAI YES-#of Devices:56 <br /> SELECT SCOPE(REQUIRED): ❑Data E Intercom ❑Thermostat t_.tt°°^^�� <br /> !Audio Ei Secure Access CI Security System <br /> ©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 /> 0 Other(List All): <br /> CODE COMPLIANCE <br /> IS THiS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO El e . <br /> ElBy checking this box,I am stating that I have read and understand all of WAC 296-46B-900 selected he specificeaslon 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:ONOor <br /> Pursuant to ROW 19.28.261,property owners and Leaseholders cannot perform electrical work on buildings for rent,sale,oritease <br /> Pg. <br /> 3 <br /> fl <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):40-32 BLDG COL E16,5 <br /> OWNER MAILING ADDRESS: STREET 3003 WEST CASINO ROAD 40-32 BLDG COL E16.5 <br /> cn EVERETT - <br /> 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 /> STY SEATTLE STATE WA ZIP 98107 <br /> CONTRACTOR PHONE:206-632-2810 CONTRACTOR EMAIL:kmuileil <br /> 1 ta"?.gawfirt3.com <br /> CONTRACTOR LIC.#(REQUIRED):ALEXAGF097NW }CITY OF EVERETT BUSINESS LIC,#(REQUIRED):050029 <br /> PRIMARY CONTACT: ]OWNER EjCONTRACTOR <br /> ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-718-1009 <br /> KEVIN MULLEN <br /> CONTACT EMAIL:kmtaliert@gowflre.com <br /> AGREEMENT.:1 hereby certify that t have read and examined this application and know the same to be true and correct AC 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 provkions of any other slate or <br /> local law regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application Is matte and <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT#: <br /> Cr, erfAuthorized Agent Signature Date <br /> (Revised 1/11r2019) Page 1•Appllcation <br /> ii <br />