3523 BROADWAY 2019-06-19 - Laserfiche WebLink

IIP EL ;TRICAL PERMIT APPLIC PION " �� CITY OF EVERETT PERMIT SERVICES - - 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 3523 Broadway Ave. Everett, Wa BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE FI DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK — CONTRACT PRICE OF WORK: $ 500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Remove existing fuel controller and replace with controller for new POS. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑ YES-Select Scope: ❑ Service El Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 1 SELECT SCOPE(REQUIRED): ✓❑ Data ❑ Intercom ❑ Thermostat ❑Audio ❑ Secure Access ❑ 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. ❑ Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: L I- NO El 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. EYES YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: f(-,1 E INO YES-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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Brown Bear Car Wash TENANT BUSINESS NAME(If Commercial): Brown Bear Car Wash OWNER MAILING ADDRESS: STREET 3523 Broadway Ave. Everett STATE Wa ZIP 98201 OWNER PHONE: 206-659-9129 OWNER EMAIL: CONTRACTOR NAME: SME Solutions CONTRACTOR ADDRESS: STREET 10107 S. Tacoma Way #A2 CITY Lakewood STATE Wa zip 98499 CONTRACTOR PHONE:253-572-3822 CONTRACTOR EMAIL: markv@sme-solutions.com CONTRACTOR LIC.#(REQUIRED):SOSL931 K1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):045511 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-405-8642 Mike Parker CONTACT EMAIL: mikep@sme-solutions.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 comity with_the State Contract. s Law 18. 'CW and 296.200 WAC. City of Everett Official Use Only PERMIT#: C er/Authorized •2 't Sigfiature to (Revised 1/11/2019) Page 1-Application