3927 RUCKER AVE BASE FILE 2020-01-30

ELECTRICAL PtMIT & FIRE ALARM PEIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 _(i (P)425-257-8810 i FAX 425-257-8857 i (E) everetteps@everettwa.gov i www.everettwa.gov/permits 4.77- PROJECT SITE INFORMATION PROJECT ADDRESS:3927 Rucker Ave Everett PROJECT TYPE: ❑ NEW CONSTRUCTION ADDITION ❑ TENANT IMPROVMENT ❑✓ REMODEL BUILDING USE: Q SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL BUILDING AREA: Roof,3rd floor sq ft 1000 ELECTRICAL APPLICATIO ,, FORMATION CONTRACT PRICE OF WORK: $9175 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑✓ NO ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? ✓❑ NO ❑ YES-Plans required for review(Both Electrical and Fire Department inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: (2) Chiller replacement. (1) Re-use of existing circuit downsized from 47A to 45A 480v 3ph (1) upsized circuit from 57A to 66A 480v 3ph. IS THIS PERMIT EDUCATION, INSITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO ❑✓ YES--See Below&Pg. 2 I 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: LINO 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Everett Clinic TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET3927 Rucker Ave cin Everett STATE WA ZIP 98201 OWNER PHONE:4252591160 OWNER EMAIL:MKimberlin@everettclinic.com CONTRACTOR NAME:EC Company CONTRACTOR ADDRESS: sTREET981 Powell Ave SW cny Renton STATE WA ziP 98057 CONTRACTOR PHONE:206-242-3010 CONTRACTOR EMAIL:Charles.Myers@ecpowerslife.com CONTRACTOR LIC.#(REQUIRED):ECCOM"148BA CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 051774 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-412-3005 Charles Myers CONTACT EMAIL:Charles.Myers@ecpowerslife.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 goveming 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 PERMIT# ii// j� I lV / (/ Charles Myers � — 1/9/19 ' _/1 1- c- `CI Owner/Authorized Agent Signature Date (Revised 11/5/2018) Page 1-Application