2707 COLBY AVE DAVITA NEPHROLOGY PRACTICE 2020-02-06

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits OLT PROJECT SITE INFORMATION PROJECT ADDRESS: 2707 Colby Ave Suite 718 BUILDING AREA: 2000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION L✓_I ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU PI MULTI-FAMILY-#OF UNITS: 7 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1200 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 1 LE for Call Light Installation 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:1 LE SELECT SCOPE(REQUIRED): ❑ Data Li 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):Light Installation CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Ir J NO ❑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: ❑NO 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_ , . _ , OWNER NAME: Davita NPS TENANT BUSINESS NAME(If Commercial):Davita NPS OWNER MAILING ADDRESS: STREET 2707 Colby Ave Suite 718 c,„ Everett STATE WA 7,98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: EC Electric '1/42/ ; (-6(\"‘ 1)M71,1 CONTRACTOR ADDRESS: STREET2121 NW Thurman cn-y Portland STATE OR 7t, 97210 CONTRACTOR PHONE:503.224.351 1 CONTRACTOR EMAIL:kriStin.Schofield@ecpowerslife.com CONTRACTOR LIC.#(REQUIRED):49737 26-45C EC ECCOM**148BA CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 051774 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:I hereby certify that!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 taw 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 t comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: - �z ei , o � -LI J -LI Ownuthonzed Agent Signature — t � to (Revised 1/11/2019) Page 1-Application