9900 19TH AVE SE WINCO FOODS 2019-07-25

# ECTRICAL PERMIT APPLICA ON 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.govlpermits PROJECT SITE1NFORMATION PROJECT ADDRESS: 9900 19th Ave SE BUILDING AREA: 115624 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION J TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX El ADU MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8 ' EL+IRIPTItN t3P=WORK CONTRACT PRICE OF WORK:$ 63701.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Lighting Retrofit- Replace existing overhead Fluorescent lamps and ballast with New LED lamps and ballast throughout Store THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope:❑Service ❑Feeder El Circuits-#. ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑Intercom El Thermostat El 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. Cl Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO El YES—See Below&Pg.2 C 1 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 DYES-See Below&Pg.3 (l 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: WinCo Foods TENANT BUSINESS NAME(If Commercial):WinCo Foods OWNER MAILING ADDRESS: STREET 650 N Armstrong PI cry Boise STATI.ID ZIP 83704 OWNER PHONE:(208) 377-0110 OWNER EMAIL: CONTRACTOR NAME: Lights Inc CONTRACTOR ADDRESS: sTREET3723 Serene Way CITY Lynnwood STATE WA zP 98087 CONTRACTOR PHONE:206-949-3188 CONTRACTOR EMAiL.:Jsegura@lightsinc.com CONTRACTOR LIC.#(REQUIRED):LIGHTI*830R7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):59845 PRIMARY CONTACT: El OWNER [ICONTRACTOR [_]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206_949-3188 Junior Segura CONTACTEMAIL:Jsegura@lightsinc.com AGREEMENT.I hereby certify that 1 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 . the,te.Fontractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: ° Date (Revised 1/11/2019) Page 1-Application CJvrner(Authorized Ag�nt Signature