319 76TH ST SW T MOBILE ANTENNA 2019-08-14

ELECTRICAL PERMIT APPLIumTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.goy I www.everettwa.gov/permits PROJECT SITE INF RM'[Am n �. — PROJECT ADDRESS: 319 76th St SW BUILDING AREA: 200 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ['COMMERCIAL IC. ,PLIc TIICN iNfOitomArgoi'44AsCRiPTION OF WORK z.. CONTRACT PRICE OF WORK:$ 24,000 ASSOCIATED BUILDING PERMIT#(if applicable): B1901-032 DESCRIBE SCOPE OF WORK: Install 200-amp ATS for standby generator. 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: 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):ATS and Alarming CODE':COMPU CNCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO ❑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. r-1 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. OWNER NAME: TENANT BUSINESS NAME(If Commercial): T-Mobile OWNER MAILING ADDRESS: STREET 1037 Thomas Ave SE cm{ Renton STATE WA zIP 98373 OWNER PHONE:206-947-5775 OWNER EMAIL:John.Rego@sacw.com CONTRACTOR NAME: Legacy Telecommunications CONTRACTOR ADDRESS: STREET PO Box 360 CITY Burley STATE WA zip 98322 CONTRACTOR PHONE:253-858-0214 CONTRACTOR EMAIL:rlundin@legacypower.corn CONTRACTOR LIC.#(REQUIRED):CC LEGACTL821LL CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 042661 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-858-0214 Ryan Lundin CONTACT EMAIL:rlundin@legacypower.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#: L:u2 //.. ER 05/06/2019 ` \Gt 05- OL -t-)) Owner/Ad Agent Signature Date (Revised 1/11/2019) Page 1-Application