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3726 COLBY AVE 2019-09-04
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3726 COLBY AVE 2019-09-04
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9/4/2019 2:43:01 PM
Creation date
9/4/2019 2:43:00 PM
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Address Document
Street Name
COLBY AVE
Street Number
3726
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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> 0477- <br /> ... . ,.et, :-.--.1,,,':- PROJECTS N1 RNITs <br /> PROJECT ADDRESS: 3726 Colby Ave BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL <br /> ,.,, 'ELEVTRC . `.. 'I F l A'"I,,. . &. D ,,.msC IPI ION WO 3, .. <br /> CONTRACT PRICE OF WORK: $ 375.00 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> MOHS BLDG. New dedicated 30 amp single phase heat pump circuit <br /> EC1945 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? El NO ❑✓ YES-Select Scope: El Service ❑ Feeder ❑✓ Circuits-#:1 El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO ✓❑YES-#of Devices:1 <br /> SELECT SCOPE(REQUIRED): 0 Data El Intercom ❑Thermostat ❑Audio El Secure Access ❑ Security System <br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> ❑Other(List All): <br /> IS THIS .., .. -?;4F.:;,,,,-7,:- <br /> .- . �.. ,a ..._ .�. <br /> PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO • YES--See Below&Pg.2 <br /> 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review. <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO DYES-See Below&Pg. 3 <br /> Ini I Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br /> without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and <br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> •1 J TIO ',. �� <br /> 4 <br /> OWNER NAME: The Everett Clinic TENANT BUSINESS NAME(If Commercial): The Everett Clinic <br /> OWNER MAILING ADDRESS: STREET 3901 Hoyt Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-259-0966 OWNER EMAIL: <br /> CONTRACTOR NAME: Dutton Electric Company, Inc. <br /> CONTRACTOR ADDRESS: STREET 12407 Mukilteo Speedway,A170 <br /> CITY Lynnwood STATE WA ZIP 98087 <br /> CONTRACTOR PHONE:425-347-7600 CONTRACTOR EMAIL:info@duttonelectric.com <br /> CONTRACTOR LIC.#(REQUIRED):DUTTOEC137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019811 <br /> PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ['OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-409-4854 <br /> Brad Morin CONTACT EMAIL:info@duttonelectric.com <br /> 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 <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only _ <br /> PERMIT#: /� <br /> Peita Smith ; p itally signed by Peita Smith E l v I'6 6 (-)t40 <br /> 4 1 q <br /> °.:Date:2019.05.0610:21:58-0700' 111 l ..J// �.! <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />
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