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ELECTRICAL PHMIT & FIRE ALARM PEIT APPLICATION
<br /> CITY OF T S
<br /> b#1111.d--741
<br /> 3200 CEDAR EVERETT STREET, EVERETTPERMIT ,WAERVICES
<br /> 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS:3003 West Casino P)1 i!' '-®1 0,,6,1 �✓'9 p
<br /> PROJECT TYPE: NEW CONSTRUCTION Q ADDITIO4 aTENANT IMPROVMENT nREMODEL
<br /> BUILDING USE: FR 0 TOWNHOUSE 0 'UPLEX !5 l4DU 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL
<br /> BUILDING AREA: 3000 Y sq ft
<br /> 4„4�c\__ .\.,a 4 ,•sl 11 ger, ,i `,', ''.INFO :Rtitr: iNX a
<br /> CONTRACT PRICE OF WORK:$47,000.00 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES:
<br /> IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
<br /> mak\ c\ \ • • •
<br /> DESCRIPTION OF WORK: Relocating (30) receptacles. Replacing existing lights with new LED troffers.
<br /> Also we will be working on (19) Light fixtures, (35) switches, and (5) circuits. Job #2000243
<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> I�I 1 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
<br /> u 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 /> ® Pursuant to RCW 19.28.261,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 have completed and signed the
<br /> See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement.
<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): Boeing
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Prime Electric
<br /> CONTRACTOR ADDRESS: STREET 13301 SE 26th Street
<br /> CITY Bellevue STATE WA ZIP 98005
<br /> CONTRACTOR PHONE:425-747-5220 !CONTRACTOR EMAIL: permits@primeelectric.com
<br /> CONTRACTOR LIC.#(REQUIRED):PRIMEEI134BT CITY OF EVERETT BUSINESS LIC #(REQUIRED) 19946
<br /> PRIMARY CONTACT: 0 •WNER CONTRACTOR L=]OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-429-4654
<br /> Mike Kinney CONTACT EMAIL: permits@primeelectric.com
<br /> 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
<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 of construction. 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 RCW and 296.200 WAC.
<br /> �D.` ` S,
<br /> .M signed by Zachary Stockand City of Everett Official Use Only
<br /> �� PERMIT#
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<br /> zs ;kand@primeelectric.com,
<br /> Zachary Stock i. P" a Electric, Inc.",
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<br /> S�
<br /> istant,Owner/Authorized Agent Signature
<br /> (Revised 10/30/2018)
<br /> „'; ,:;4.4 d ,hary Stockand
<br /> Ti 18.11.13 10:17:57-08'00'
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