3003 W CASINO RD BLDG 40-05 2019-06-19

r.ECTRICAL PERMIT APPLIUMTION '1111P#1 ::4 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: 3003 WEST CASINO ROAD BLDG 40-5 E-6 BUILDING AREA: sq ft PROJECT TYPE: Cl NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION.INFORMATION 8"DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Wire up new roll up door at E-6 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO EI YES-Select Scope: El Service ❑ Feeder a Circuits-#:1 El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:I SELECT SCOPE(REQUIRED): 0 Data El Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑Security System El 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): CODECOIIIPLIARC IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO ❑YES—See Below&Pg.2 By checking this box,I am stating that I have read and understand all of WAC 296-4613-900,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 See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. :..NTA s ORMATION: OWNER NAME: THE BOEING COMPANY TENANT BUSINESS NAME(if Commercial): THE BOEING COMPANY OWNER MAILING ADDRESS: STREET PO BOX 3707 MS 1 F09 crry SEATTLE STATE WAziP 98124 OWNER PHONE:(425)294-0514 'OWNER EMAIL: CONTRACTOR NAME: DUTTON ELECTRIC COMPANY, INC. CONTRACTOR ADDRESS: STREET 12407 MUKILTEO SPEEDWAY A-170 crrr LYNNWOOD STATE WA Zip 98087 CONTRACTOR PHONE:(425)347-7600 (CONTRACTOR EMAIL:info@duttonelectric.com CONTRACTOR LIC.#(REQUIRED):DUTToEc137P3 1CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425)599-5410 Andy Kisch CONTACT EMAIL:andyk@dultonelectric.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 ROW and 296.200 WAC. City of Everett Official Use Only PERMIT Date:2019.03.78 tt:5fi:06-UTGO #: Peila Smith E1,0163- V) Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application