|
Elr_ECTRICAL PERMIT APPLIITION
<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 I www.everettwa.gov/permits
<br /> 477-
<br /> iy
<br /> Yb� �y
<br /> ,," 3��n iPRR�EwcT SITE MN.> 'ORMATION
<br /> PROJECT ADDRESS: 7600 Evergreen Way BUILDING AREA: sq ft
<br /> PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL
<br /> BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ECOMMERCIAL
<br /> ELECTRICAL APPLICATION IN,& tl
<br /> INFORMATION
<br /> uo . . .;"!„ffi:,. ' ifN .._...
<br /> CONTRACT PRICE OF WORK:$ 378.74 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> New Dedicated Fan Circuti
<br /> EC1934
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#:1 ❑Complete Re-wire
<br /> LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:1
<br /> SELECT SCOPE(REQUIRED): El Data El Intercom ❑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):
<br /> .° CODE C:O14Pt„1
<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO El 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: ONO 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 /> .... L.. . TA I. It? 4 �s ,. \ fit ...
<br /> OWNER NAME: The Everett Clinic TENANT BUSINESS NAME(If Commercial): The Everett Clinic
<br /> OWNER MAILING ADDRESS: STREET 3901 Hoyt Ave
<br /> cin 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,Al 70
<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 /> „,,,,L.,2,,,,,,, ,»
<br /> ,,•, ,a. ....,... mow.,. ,,u, »„»»�,.�.... ,,,,.,,, . , Ali,
<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 :vitally signed by 113 Smith
<br /> E \ 1, 1_k 0.00Z
<br /> .4Ete:2019.04.05 1 1 13:26-07'00'
<br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application
<br />
|