729 100TH ST SE WA STATE LABOR AND INDUSTRIES 2019-08-15

I ECTRICAL PERMIT APPLI1 1ION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits 477- PR f: :INF, O14 T..,w.: PROJECT ADDRESS: 729 100TH ST SE BUILDING AREA: 2500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELEC ICppu r,"' INI=ON 4.P,.,� , .?,,.., ._' ` CONTRACT PRICE OF WORK: $ 2,500 ASSOCIATED BUILDING PERMIT#(if applicable): N/A DESCRIBE SCOPE OF WORK: PROVIDE CAT6 CABLING FOR POE CAMERAS. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑✓ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices: 1 EACH SELECT SCOPE(REQUIRED) ✓❑ Data ❑ Intercom El Thermostat ❑Audio El 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. El Other(List All): ?� x ��;A• ' � a.. : :•. map,:; :..:' �. .'.. . ..a.a�, ;a..„.a :: CODE NIP MI CE ,,,,,Vg,-1:1;,F,''' IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO El 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: ONO EYES-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 t R EZ -' OWNER NAME: Johnson Family LMT Partners TENANT BUSINESS NAME(If Commercial): Dept. of Labor and Industries OWNER MAILING ADDRESS: STREET PO BOX 5253 CITY EVERETT STATE WA Z,P 98206 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CTS CONTRACTOR ADDRESS: sTREET2720 S. ASH ST. CITY TACOMA STATE WA Z,P 98409 CONTRACTOR PHONE:(206)686-2000 CONTRACTOR EMAIL:EmilyT©cableCTS.com CONTRACTOR LIC.#(REQUIRED):CTS**TS881 BK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 048173 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(360)951-8124 John H o rg e r CONTACT EMAIL:JohnH@cableCTS.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#: Eke/i Ta GoY 02/28/2019 E T " a�- — C0 S Owner/Authorize1 Agent S nature Date (Revised 1/11/2019) Page 1-Application