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,0114„, ELECTRICAL PERMIT & FIRE ALARM PERMIT APPLICATION
<br /> 04119111P.„ ---_,_A CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov J www.everettwa.govipermits
<br /> PROJECT ADDRESS: 3003 W Casino Rd, 4 idg 45-533, Ev-rett WA 98204 -
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<br /> PROJECT TYPE:LINEA/CONSTRUCT!,: Ej ADDIT 1:, 121 ENANT IMPROVMENT 1REMODEL
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<br /> BUILDING USE: riffSFR 0 TOWNIIOUS Ill 0 UPLEX 0 ADU ,Fo—MULTI-FAMILY-#OF UNITS: al COMMERCIAL
<br /> BUILDING AREA: 2000 sq ft
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<br /> CONTRACT PRICE OF WORK:$2000 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IS THIS LOW VOLTAGE WORK? 0 YES-#OF DEVICES: 18
<br /> NO 0
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<br /> IS THIS A FIRE ALARM PERMIT? 0 0 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required)
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<br /> DESCRIPTION OF WORK: Install Access Control Devices for(2)Doors. Install Access control panel and power supply:120v by others
<br /> Titan Electric job#186280
<br /> THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES:
<br /> 1".1- By checking this box,I am stating that I have read and understand all of WAC 29646B-900,selected the specific reason on page 2
<br /> 1.1 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 /> 13 Pursuant to RCW19..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 /> trPtadiVtnigill,'',';!.019/E0g:3,W,:..1.71,:j:Mir0,01011000fiaiLiZeMPLA:4-.L;',1, 271TEI
<br /> OWNER NAME: Boeing TENANT BUSINESS NAME(If Commercial): Boeing
<br /> OWNER MAILING ADDRESS: smear 3003 W Casino Road
<br /> cry Everett STATE WA zip 98204
<br /> OWNER PHONE: 312 544 2000 OWNER EMAIL:
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<br /> CONTRACTOR NAME: Titan Electric .
<br /> CONTRACTOR ADDRESS: STREET 12828 Northup Way, Suite 205
<br /> ary
<br /> Bellevue.
<br /> STATE WA zip 98005
<br /> CONTRACTOR PHONE 206 633 2811 CONTRACTOR EMAIL: Permits@titanelectric,net
<br /> CONTRACTOR LIC.#(REQUIRED):TITANEISSSOB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 051191PRIMARY CONTACT: ti OWNER 1-0-- ONTRACTOR [ ]OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 206 551 7253
<br /> Sean Hughes CONTACT EMAIL: seanh@titanelectric.net
<br /> AGREEMENT:!hereby certify that l have read and examined this application and know the same to be true and correa 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 /> City of Everett Official Use Only
<br /> PERMIT#
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<br /> Owner/Authotized Agent Signature Date (Revised 10/30/2018)
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