8710 5TH AVE W 2019-05-23 - Laserfiche WebLink

LLECTRICAL PERMIT APPLICATION 004P" LLECTRICAL CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits ._.= ...:.. s.. ' .. .::\ ,. PROJECT ADDRESS: 8710 5th Ave W, Everett, WA 98204 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ✓❑ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX El ADU ❑✓ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL .'e ..fie s� >E .... .. , . :: _ .��`l...O��...r�S1aa\��CeS�. �"- ..'ce � .� �a\��ka�.\��o�..n,,�.\e. 4{�.aa.• CONTRACT PRICE OF WORK:$ 1800.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 4 exit signs THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope: El Service ❑Feeder ©Circuits-#:1 ❑Complete Re-wire LOW VOLTAGE WORK? El NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data El Intercom Cl Thermostat ❑Audio ❑Secure Access El Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. El Other(List All): IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: • NO I YES--See Below&Pg.2 I--1By 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: ■NO ■YES-See Below&Pg. 3 1ri 1 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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. i p \ �.• x p s aF•a\,W� : \ ., . OWNER NAME: TENANT BUSINESS NAME If Commercial : Cascadia Pointe OWNER MAILING ADDRESS: STREET 8710 5th Ave W, Everett, WA 98204 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Innovative Systems Tech CONTRACTOR ADDRESS: STREET 1402 Lake Tapps Pkwy SE, STE 104-147 CITY Auburn STATE WA ZIP 98001 CONTRACTOR PHONE:253-891-1226 CONTRACTOR EMAIL:moriajensen@ist-fse.com CONTRACTOR LIC.#(REQUIRED):INNOVST881 B4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53753 PRIMARY CONTACT: DOWNER ©CONTRACTOR MOTHER(Please Speci ) , \\�„ \\� CONTACT NAME: CONTACT PHONE:253-891-1226 Moria Sand CONTACT EMAIL:moriajensen@ist-fse.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/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 -7,,� PERMIT#: 114,4 a, 04/17/2019 E Y OE D q' L ` Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application