11020 19TH AVE SE BARTELL DRUGS 2019-06-11

i1 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits 477- PROJECT SITE INFORMATION PROJECT ADDRESS:11020 19th Ave SE, Everett WA 98028 PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT [1 REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL BUILDING AREA: sq ft , ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $400. 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) DESCRIPTION OF WORK& CODE COMPLIANCE DESCRIPTION OF WORK: Add (1) 120v 20a circuit in existing in-slab conduit. IS THIS PERMIT EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO II YES--See Below&Pg. 2 ❑ 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. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO EYES-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 INFORMATION OWNER NAME: Coastal Serhoe TENANT BUSINESS NAME(If Commercial): Bartell Drug Store OWNER MAILING ADDRESS: STREET6 S. 2nd St. Suite 315 ,,,, Yakima STATE WA ZIP 98901 OWNER PHONE:425-508-3056 OWNER EMAIL: CONTRACTOR NAME:Bartell Drug Store CONTRACTOR ADDRESS: STREET4025 Delridge Way SW Suite 400 CITY Seattle STATE WA zip 98106 CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Electrician CONTACT NAME: CONTACT PHONE:206.915.2976 Craig Anderson CONTACT EMAIL:craig.anderson@bartelldrugs.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# 0 ___ / U.(6- 0 '- l'A , .0.. ......z. 4.--- •, ner/Authorized A..nt Signature Date g (Revised 11/5/2018) Page 1-Applicatio_n„ ( -1/3/) 1 3/�)