3726 BROADWAY GATEWAY SURGICAL CENTER 2020-01-21

EEECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 T (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits *6-7-1- T°SII""S'1NF+ ATN PROJECT ADDRESS: 3726 BROADWAY #201 and #206 BUILDING AREA: 8011 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: _.71COMMERCIAL ELECTRICAL APPLICATION INFORMATION&DESCRIPTION OF ,n. ', CONTRACT PRICE OF WORK: $ 3000 ASSOCIATED BUILDING PERMIT#(if applic le): A1909-005 DESCRIBE SCOPE OF WORK: - RELOCATE HORN STROBE AND INSTALL 3 STROBES IN NEW PATIENT ROOMS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:4 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ 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): COD CO P IAN r , W. IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: CI NO IJ YES--See Below&Pg.2 ✓ 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 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: ENO EYES-See Below& Pg. 3 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 r OWNER NAME: TENANT BUSINESS NAME(If Commercial): MPB GATEWAY CENTER LLC OWNER MAILING ADDRESS: STREET 3732 BROADWAY c,T,. EVERETT STATE WA ZIP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: AAA FIRE PROTECTION CONTRACTOR ADDRESS: STREET 3013 3RD AVE N CITY SEATTLE STATE WA ZIP 98109 CONTRACTOR PHONE:206-284-1721 CONTRACTOR EMAIL:BOYD@AAAFIRE.COM CONTRACTOR LIC.#(REQUIRED):AAAFIFP841N3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 027647 ...ate ,,; , PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-284-1721 BOYD SODERQUIST CONTACT EMAIL:BOYD@AAAFIRE.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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMITE #: ` BOYD SODERQUIST 10/15/2019 \ \ ` 0 - ')__2-- Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application