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ELECTRICAL RMIT & FIRE ALARM P R ITLI T <br /> APP A IC?N <br /> CITY OF EVERETT PERMIT SERVICES <br /> . 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I. FAX 425-2 s7-8857 { (E)evefetteps 7everettwa.gov I www,everetNva.gov/permits <br /> ra.govfpermits <br /> �„ . _. $ ter. _s3 ', - `., _ ��e <br /> 5r. -'-'-'4.N. Wim.,.-g,-..a _ 2',��« d iic.,s.n,,,--wc..`a ; :_."�'aS�M.�.e_.-. • ,S.��M h-..z� ._._�., .-k. ,e..� _.,-... ". <br /> PROJECT ADDRESS:3003 W Casino Rd, Bldg 40-37, Everett WA 98204 <br /> PROJECT TYPE:aNIEW CONSTRUCTION 0 ADDITION 121 ENANT IMPROVMENTJIREMODEL <br /> BUILDING USE: 1173—SFR 0 TOWNHOUSE 0 IUPLEX , 0 DU :D MULTI-FAMILY-#OF UNITS: I;COMMERCIAL <br /> BUILDING AREA: 5,000 sq ft <br /> +, 0 t._ , e,„:, ,, ,. * . ., .,„11;irk._. <br /> CONTRACT PRICE OF WORK:$2000: ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IS THIS LOW VOLTAGE WORK? 0 NO YES-#OF DEVICE :: 1 <br /> IS THIS A FIRE ALARM PERMIT? El 0 0 YES-Plans required for review(Both Eleotrical and Fire Department inspections:are required) <br /> w ; <br /> DESCRIPTION OF WORK: Install Access Control Devices for(2)Gates.Install Access control panel and power supply,120v by others <br /> Titan Electric job#186177 <br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: , <br /> TT By checking this box,I am stating that I have read and understand all of WAC 296-468400,selected the specific reason on page 2 <br /> 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 /> ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: <br /> roll Pursuant to RCW'19.28261,property owners and leaseholders cannot perform electrical work on buildings for rent sale,or lease without <br /> the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I havecompleted and signed the <br /> see Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> t S a ' 4 ` if : sto „° ' 17' AVAt .cap„ <br /> OWNER NAME: Boeing TENANT BUSINESS NAME(If Comnrlercllal): Boeing, <br /> OWNER MAILING ADDRESS: ersesr 3003 W Casino Road <br /> crit' Everett STATE WA zip 98204 <br /> OWNER PHONE: 312 544 2000 OWNER EMAIL: <br /> CONTRACTOR NAME: Titan Electric? <br /> CONTRACTOR ADDRESS: sTREET 12828 Northup Way, Suite 205 <br /> cry Bellevue STATE WA zip 98005 <br /> CONTRACTOR PHONE:208 633 2811 CONTRACTOR EMAIL: perrnits@titanelectric.net <br /> CONTRACTOR LIC.#(REQUIRED) TITANE196309 jCITY OF EVERETT BUSINESS LIC,if/REQUIRED): 051191 <br /> PRIMARY CONTACT: DOWNER ,c,-fr ,ONTRACTOR 0011-15F2(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 551 7253 <br /> Sean Hughes CONTACT EMAIL; seanh@titanelectric.net <br /> AGREEMENT:I'herebycertify that I have read and examined thisapplication and know the same to be true and correct. All provisions of laws and ordinances <br /> 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 <br /> provisions of any other state or local law regulating construction or the performance ofconstruction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 ROW and 296.200 WAG: <br /> City of Everett Official Use Only <br /> PERMIT' <br /> #` <br /> Ii11-- El (2- oo3 <br /> Owner/Authorized Agent;Signature. Date (Revised 10/3012018 <br />