701 75TH ST SE BLDG 5 SHORESIDE VILLAGE 2025-05-16

aims ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 wasrnh'oTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettvra.govipermits • • • . 'PROJECT SITE INFORMATION a: PROJECT ADDRESS: 701 75th St SE APT#51 1 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU DD MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ,._ ELECTRICAL AP:PAW-AMON,INFORMATION ..,DESCRIPTION OI WORK, CONTRACT PRICE OF WORK:$ 900.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Replace old panel with new 125A ML panel THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope:El Service ❑ Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑ YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data El intercom ❑Thermostat ❑Audio ❑Secure Access El 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. El Other(List All): CODE COMPLIANCE,., IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ❑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. DYES ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑NO DYES-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 licensingfcertification requirement. OWNER NAME: Williams Investment TENANT BUSINESS NAME(If Commercial):empty unit OWNER MAILING ADDRESS: smear 19801 50th Ave W CM, Lynnwood STATE WA 21p 98036 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Rhema Electric CONTRACTOR ADDRESS: sTREET628 South Spruce Street ciry Burlington STATE WA op 98233 CONTRACTOR PHONE:360-416-8227 CONTRACTOR EMAIL:daveb C©rhemaeleCtriC.COm CONTRACTOR LIC.#(REQUIRED):RHEMAEL940DH CITY OF EVERETT BUSINESS LIC.#(REQUIRED):45783 PRIMARY CONTACT: DOWNER DCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-630-0164 B 6, `' CONTACT EMAIL:daveb@rhemaeiectric.com AGREEMENT:t hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws end ordinances governing this typo 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 arte t corn ily wtih.,fhe State Contrac ors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: g (-,Jj1. ?ID OwnerlAf tl orized Agent Signature Date (Revised 1/11/2019) Page 1-Application