910 SE EVERETT MALL WAY PEARLE VISION 2024-06-21

ECTRICAL PERMIT APPLI•TION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:910 SE Everett Mall Way,Suite 103 BUILDING AREA: sq ft PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: Q COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$800.00 ASSOCIATED BUILDING PERMIT#(if applicable):B2204-058 DESCRIBE SCOPE OF WORK: Installation of three(3)thermostats and three(3)temperature sensors. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO ❑YES-Select Scope:❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑✓ YES-#of Devices:6 SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ✓❑Thermostat ❑Audio ❑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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ENO LI 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:LINO 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:Rand'S 910 Center LLC TENANT BUSINESS NAME(If Commercial): Pearle Vision OWNER MAILING ADDRESS: STREET 15015 Main St,Suite 203 Bellevue STATE WA ZIP 98007 OWNER PHONE:425-746-6066 OWNER EMAIL:blake@pfinvestments.com CONTRACTOR NAME:Evergreen Refrigeration CONTRACTOR ADDRESS: STREET 727 S Kenyon St CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE:206-763-1744 CONTRACTOR EMAIL:alexb@evergreenhvac.com CONTRACTOR LIC.#(REQUIRED):EVERGRL813MA CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044350 PRIMARY CONTACT: DOWNER E CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-763-1744 ext.247 Alex Burkhart CONTACT EMAIL:alexb@evergreenhvac.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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: L✓r 7/1/22 E 2207-0(0q Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application