1710 100TH PL SE 2024-04-01 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1(E)PermitServices@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:1710 100TH PLC SE EVERETT WA 98208 IBUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $396.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ADD CELLULAR COMMUNICATION ON EXISTING SECURITY SYSTEM ADD CELLULAR COMMUNICATION ON EXISTING SECURITY SYSTEM THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO [I YES-Select Scope:❑Service ❑Feeder ❑ Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO Z YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access 21 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: 0 NO LJ 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 []YES-See Below&Pg. ❑ 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: TENANT BUSINESS NAME(If Commercial):SCHUMACHER LEASINC. OWNER MAILING ADDRESS: sTREETPO BOX 949 ,,, MUKILTEO STATE WA Z1P98275 OWNER PHONE:206-715-9000 OWNER EMAIL:JiM@LeaSingRealestate.COPTI CONTRACTOR NAME:COMMERCIAL ALARM & DETECTION CONTRACTOR ADDRESS: STIEET17199 BENNETT RD c,, MOUNT VERNON SLATE WA ...98273 CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):COMMEA1948L0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):043019 PRIMARY CONTACT: DOWNER EICONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-848-1533 EXT 108 RO N S KO R I C K CONTACT EMAIL:RON@CFI REPRO.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/ comply with the State C actors Law 18.27 RCW and 296.200 WAC. -' City of Everett Official Use Onl PERMIT#. 3/20/23 E Ow orized Agent Signature Date (Revised 4/5/2022) Page 1-Application