6132 EVERGREEN WAY 2024-12-02 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 i FAX 425-257-8857 i(E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6132 Evergreen Way, Everett WA 98203 1 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT s❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 5,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK:(N1) Freestanding Sign: Wire led illuminated Chevron monument to existing electrical. (Cl-C6) Canopy Signs: Wire led illuminated Chevron canopy signs to existing electrical circuit(s). (W1) Wall Sign: Wire led illuminated Extra Mile wall sign to existing electrical circuit. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? s❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ✓❑ Circuits-#:4 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ✓❑YES-#of Devices: 12v-60w LED SIGNS 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):2 @ 20amp Circuits(LED ILLUMINATION) CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: 71 NO Ll 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.3 ❑ 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: MICHAEL'S PETROLEUM, INC TENANT BUSINESS NAME(If Commercial): Evergreen Chevron OWNER MAILING ADDRESS: STREET 6132 Evergreen Way ,,n, Everett STATE WA Zlp 98203 OWNER PHONE:425-917-2109 OWNER EMAIL:Steven@InslgnlaSlgn.com CONTRACTOR NAME: Insignia Sign CONTRACTOR ADDRESS: STREET325 Burnett Ave N ciTv Renton STATE WA Z,p 98057 CONTRACTOR PHONE:425-917-2109 CONTRACTOR EMAIL:Steven@insigniasign.com CONTRACTOR LIC.#(REQUIRED):INSIGSR8191_8 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): FILELOCAL PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-917-2109 Steven Thomson CONTACT EMAIL:steven@insigniasign.com AGREEMENT:/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 1 am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: 1!7t % � E Steven Thomson 12/12/22 Owner/Authorized Agent Signature Date (Revised 1/1 112 0 1 9) Page 1-Application