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Jan 30 2019 03:50PM HP Fax page 2
<br /> 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 I www.everettwa.gov/permits
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<br /> PROJECT 1800 41st Street 5th Floor "sq '
<br /> ADDRESS: BUILDING AREA: sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT •0 REMODEL
<br /> BUILDING USE: 0 SFR ❑TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL
<br /> . 4,E.0 7,81CAL APPJJCAYION tINF;ORMATI.ON &°' SCR PTIO
<br /> CONTRACT PRICE OF WORK:$ 5110.37 ASSOCIATED BUILDING PERMIT#(if applicable):.
<br /> DESCRIBE SCOPE OF WORK: Install 16 loudspeakers to existing sound system
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> UNE VOLTAGE WORK? p NO 0 YES-Select Scope:0 Service 0 Feeder 0 Circuits-#: 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? 0 NO ©YES-#of Devices: 16
<br /> SELECT SCOPE(REQUIRED): 0 Data 0 Intercom ❑Thermostat Audio
<br /> ❑ ❑ Secure Access 0 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):
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<br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Q NO YES—See Below&Pg.2
<br /> I
<br /> I By checking this box, I am staling 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE:ONO OYES-See Below&Pg.3
<br /> 0 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.
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<br /> OWNER NAME: TENANT BUSINESS NAME(If Commercial): The Everett Clinic
<br /> OWNER MAILING ADDRESS: STREET T 3901 Hoyt Ave
<br /> CITY Everett 98201
<br /> STATE WA ZIP
<br /> OWNER PHONE: 'OWNER EMAIL:
<br /> CONTRACTOR NAME: Point to Point Low Voltage
<br /> CONTRACTOR ADDRESS: STREET2004 196th ST SW#2
<br /> �� Lynnwood STATE WA ZIP
<br /> 98036
<br /> CONTRACTOR PHONE:425-771-7257 (CONTRACTOR EMAIL:gary@morgansounti.com
<br /> CONTRACTOR LIC.#(REQUIRED):FUN I I-'L�39ULfl CITY OF EVERETT BUSINESS LIC : 398b4
<br /> .#(REQUIRED).
<br /> PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR DOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-771-7257
<br /> Gary Parkes
<br /> CONTACT EMAIL:gary@morgansound.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 RQW and 296.200 WAC. City of Everett Official Use Only
<br /> PERMIT At;
<br /> OwneNA on A ant Signature Date (Revised 1/11/2019) Page 1-Application
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