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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:3201 SMITH AVE EVERETT WA 98201 BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT ❑REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $5500 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Fire Alarm modifications for elevator modernizations, monitoring for Shunt and Relays for recall. <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope:❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire <br /> LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices:8 <br /> SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access In Security System <br /> QFire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An <br /> additional Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: El NO LJ YES--See Below&Pg.2 <br /> ❑ 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 <br /> 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 <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ✓❑NO ❑YES-See Below&Pg. <br /> ❑ Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <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:EVERETT TRANSIT STATION TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3201 SMITH AVE <br /> ,,T, EVERETT STATE WA ziR 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:B&H FIRE AND SECURITY <br /> CONTRACTOR ADDRESS: STREET PO BOX 3711 <br /> ,,n, ARLINGTON STATE WA Z,R 98223 <br /> CONTRACTOR PHONE:425-244-1445 CONTRACTOR EMAIL:JEFF@BNHFIRE.COM <br /> CONTRACTOR LIC.#(REQUIRED):BHFIRHF842KW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 055697 <br /> PRIMARY CONTACT: [—]OWNER °❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-244-1445 <br /> JEFF BROSSARD CONTACT EMAIL:jEFF@BNHFIRE.COM <br /> AGREEMENT:I hereby certify that/have read and examined this application and know the same to be true and correct. All 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 provisions of any other state <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only <br /> E <br /> #: <br /> 2/14/2024 <br /> Owner/A01orized Agent Signature Date (Revised 41512022) Page 1-Application <br />