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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
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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 APPLILATION <br /> OLTCITY 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3726 COLBY AVE BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL <br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: Q COMMERCIAL <br /> ELECTRICAL,APPLICATION INFORMATIO$ & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ 722.79 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> Installing LED retrofit kits for (46) existing 3-lamp, T8 fluorescent fixtures and (2) 1-lamp T8 fluorescent <br /> fixtures along with (6) new dimmer switches and the associated circuits <br /> EC1946 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? ❑✓ NO E YES-Select Scope: ❑ Service El Feeder ❑✓ Circuits-#:6 ❑ Complete Re-wire <br /> LOW VOLTAGE WORK? ❑✓ NO ❑YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom E Thermostat El Audio ❑ Secure Access ❑ Security System <br /> ❑ 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): LIGHTING <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO 0 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: ❑✓ NO EYES-See Below&Pg. 3 <br /> 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 /> .......v ^_::'' .. ...... - CONTACT INFORMATION �.,.,.,A... <br /> OWNER NAME: THE EVERETT CLINIC TENANT BUSINESS NAME(If Commercial): THE EVERETT CLINIC <br /> OWNER MAILING ADDRESS: STREET 3901 HOYT AVENUE <br /> 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:4254094854 <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 /> P /,( <br /> Pita Smith digitally signed by Peita Smlth F 1 /V/ I V - t 1� <br /> Deto'9h1 Q na 1 Z nQ nA 1 0.nTM' <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />
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