2731 WETMORE AVE KM PROVIDENCE 2019-06-25

ECTRICAL PERMIT APPL . _TION �— CITY OF EVERETT PERMIT SERVICE,; 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 2731 Wetmore Ave Ste 210, 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: LJ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION':& DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1,200.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install 20amp circuit for copier THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: 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: ❑ NO EYES--See Below& Pg. 2 nI I 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below& Pg. 3 I 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. CONTACINFORNIt OWNER NAME: Kidder Mathews TENANT BUSINESS NAME(If Commercial): KM Providence OWNER MAILING ADDRESS: STREET PO Box 62764 CITY Irvine STATE CA ZIP 92602 OWNER PHONE:425.283.5788 OWNER EMAIL: CONTRACTOR NAME: Titan Electric CONTRACTOR ADDRESS: STREET 12828 Northup Way Suite 205 CITY Bellevue STATE WA zIP 98005 CONTRACTOR PHONE:206.633.2811 CONTRACTOR EMAIL:Permits@titanelectric.net CONTRACTOR LIC.#(REQUIRED):TITANEI9630B CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 51191 PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206.633.2811 CONTACT EMAIL:permits@titanelectric.net 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 1 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#: DN Cl=signed by David Crook �� David Crook°I C=ur.E=davdctt:,,,,, ectric net, L'� Da e:2 Electric, 0 45.3 7-Crook E I ` V I/' Data:2019.03.12 10.45:37-0700' Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application