2000 TOWER ST SHUKSAN HALL 2019-04-17

ELECTRICAL PERMIT & FIRE ALARM PERMIT 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 1 www.everettwa.gov/permits Orerr `!¢PROJECT SITE'INFORMATION PROJECT ADDRESS:SHUKSAN HALL-BLDG 13 2000 TOWER STREET, EVERETT,WA 98201 PROJECT TYPE: 0 NEW CONSTRUCTION E ADDITION 0 TENANT IMPROVMENT 0 REMODEL BUILDING USE: 0 SFR 0 TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATIONINFORMATION CONTRACT PRICE OF WORK:$250 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? © NO El YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? © NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTIONOflF°WORK; CCODECOMPLIANCE DESCRIPTION OF WORK: Load bank testing of emergency back uo generator IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO CI YES–See Below&Pg.2 InBy 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO DYES-See Below&Pg.3 — 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 INFORMAN. OWNER NAME: Everett CC TENANT BUSINESS NAME(If Commercial): SHUKSAN HALL-BLDG 13 OWNER MAILING ADDRESS: STREET CITY 2000 TOWER STREET STATE ZIP OWNER PHONE:(425)388-9483/ OWNER EMAIL:psnowden@everettcc.edu CONTRACTOR NAME:Pacific Power Group CONTRACTOR ADDRESS: sTREET8O5 Broadway,#700 CITY Vancouver STATE WA ZIP 98660 CONTRACTOR PHONE:253-395-9077 ,CONTRACTOR EMAIL:anokes@pacificpowergroup.com CONTRACTOR LIC.#(REQUIRED):EC PACIFPG867DII CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053000 PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-395-9077 Amanda Nokes CONTACT EMAIL:anokes@pacificpowergroup.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 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only ff PERMIT# ,in ,/ , 11 g-`-{ 1 ( Owner utho' ed Agent Signature Date (Revised 11/5/2018) Page 1-Application