10333 19TH AVE SE STE 105 2025-10-27

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 i (E) PermitServices@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10333 19th Ave SE, Ste 105 BUILDING AREA: 100 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR []TOWNHOUSE []DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS:❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 3010.00 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: scope of work is to replace failing power supply in Suite 105 scope of work is to replace failing power supply in Suite 105 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO DYES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO 0 YES- # of Devices:1 SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access In 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: El NO LJ YES -- See Below & Pg. 2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-46113-900, 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: ✓❑NO ❑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:Silver Lake Properties LLC TENANT BUSINESS NAME (If Commercial): Silver Lake Pavilion OWNER MAILING ADDRESS: STREET 15918 24th Court SE ,,T,, Mill Creek STATE VV`^, A ...98012 OWNER PHONE: 425-339-1160 OWNER EMAIL: tgish@portgardnermgmt.com CONTRACTOR NAME:Smlth Fire Systems CONTRACTOR ADDRESS: sTREET1106 54th Ave East ,,T, Tacoma STATE WA Z,P 98424 CONTRACTOR PHONE:253-926-1880 1CONTRACTOR EMAIL: FApermltS@smlthflre.com CONTRACTOR LIC. #(REQUIRED):SMITHFS861 RS CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 23577 PRIMARY CONTACT: [—]OWNER OCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Lennie Mueller CONTACT PHONE:253_248-2051 CONTACT EMAIL:lmueller@smithfire.com 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 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/ am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FE #: Lennie L Muellera �2�am,�aa,��dm4-12-2024 Owner/Authorized Agent Signature Date (Revised 41512022) Page 1-Application