505 SE EVERETT MALL WAY I LOVE KICKBOXING 2019-03-21

ELECTRICAL P MIT & FIRE ALARM PLr,t,JIIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits 0177 PROJECT SITE INFORMATION PROJECT ADDRESS: 505 SE EVERETT MALL WAY STE 3 PROJECT TYPE: ❑ NEW CONSTRUCTION [ADDITION FaTENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: O COMMERCIAL BUILDING AREA: 3600 sq ft ... , ....... ELECTRICAL.APPLICATIONINFORMATION CONTRACT PRICE OF WORK: $ 1,000.00 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO 0 YES-#OF DEVICES: 4 ` IS THIS A FIRE ALARM PERMIT? 0 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Replacing one thermostat and installing relays to control package units. THIS SECTION APPLIES TO ALL EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ErBy 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: 13 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. CONTACT INFORMATION OWNER NAME: GREENTREE PLAZA TENANT BUSINESS NAME(If Commercial): MMA OWNER MAILING ADDRESS: STREET 12411 VENTURA BLVD cm STUDIO CITY STATE CA ZIP 91604 OWNER PHONE: (425)503-1908 OWNER EMAIL: CONTRACTOR NAME: G&S Heating CONTRACTOR ADDRESS: STREET 3409 Everett Ave ,,T,, Everett STATE WA z,P 98201 CONTRACTOR PHONE: 425-309-6507 CONTRACTOR EMAIL: Jonathan Farrell CONTRACTOR LIC.#(REQUIRED): GSHEAC*939RK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19685 PRIMARY CONTACT: ❑ OWNER Ii'CONTRACTOR F5OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-309-6507 Jonathan Farrell CONTACT EMAIL: Jonathan@gsheating.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# :,z,- ,�,� f" SJ, 12-5-18 \Ot I- o�� /Owner/Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3