11400 EVERGREEN WAY 2019-02-06 - Laserfiche WebLink

ELECTRICAL P RMIT & FIRE ALARM P MIT APPLICATION CITY OF EVERETT PERMIT SERVICES /4;,:;f :F."1 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits 4 i PROJECT ADDRESS: 11400 WA-99 PROJECT TYPE: nNEW CONSTRUCTION EIADDITION WTENANT IMPROVMENT MiTe eerer BUILDING USE: itTISFR 0 TOWNHOUSE FODuPLEX IDU 0 MULTI-FAMILY-#OF UNITS: laCOMMERCIAL BUILDING AREA: unknown sq ft CONTRACT PRICE OF WORK:$1500.00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0NO 0 YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? �NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) ..... ... ... .. .. 3:x• Q \�a ., a .. .,. "ate ..?� � ., DESCRIPTION OF WORK: alter 2 existing 120 volt 20 amp circuits to supply Monster Energy coolers THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 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. ATTENTION OWNERS:THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ® 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. OWNER NAME: Manager-Rory TENANT BUSINESS NAME(If Commercial): Walmart OWNER MAILING ADDRESS: STREET 11400 WA-99 cm, Everett STATE WA ZIP 98204 OWNER PHONE: 425.923.1740 OWNER EMAIL: CONTRACTOR NAME: On Site Electric LLC CONTRACTOR ADDRESS: STREET 8825 34th Ave NE, L383 on, Marysville STATE WA ZIP 98271 CONTRACTOR PHONE:4255087375 CONTRACTOR EMAIL: onsiteelectriclIc@gmail.com CONTRACTOR LIC.#(REQUIRED):SITEESE851 BN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51327 PRIMARY CONTACT: ❑ WNER �.,ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425.508.7375 Scott Larsen CONTACT EMAIL: onsiteelectriclIc@gmail.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#,44 11/28/18 6INIH (e J Owner/Authorized Agent Signature Date (Revised 10/30/2018) s gage I-bf 3'