4933 EVERGREEN WAY VERA WHOLE HEALTH 2020-02-07

ENE ELECTRICAL PERMIT APPLICATION • CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits ERAVISPRIMUTOWANSTILOOEPTAVEIfitmwnoliztai -mszkAatim PROJECT ADDRESS: 4933 Evergreen Way, Everett WA 98203 BUILDING AREA: 3771 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL t C i ELEM:1 At P :10,M ON NFORMATIO_ ;& SCRI 'T N 11__III . CONTRACT PRICE OF WORK:$ 192,582 ASSOCIATED BUILDING PERMIT#(if applicable): Dig D4 row DESCRIBE SCOPE OF WORK: Medical clinic with 6 exam rooms, 2 consult rooms, lab and offices - install new power for receptacles and equipment from existing service, data drops, white noise speaker system, nurse call at patient restrooms THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ❑✓ YES-Select Scope:❑Service ❑Feeder ❑✓ Circuits-#:3° ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑✓ YES-#of Devices:35 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):Nurse Call IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑NO YES—See Below&Pg.2 El 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 YOUAN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ❑✓NO OYES-See Below&Pg.3 I I 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. 3^' �� i „� + c. s✓- Y F 1� N w "�` s - z.e w.Ysc f::x=. a = 3., .:. ' x,'- „x, ,�»,.w#s.xs.,.I 4, a3 3r r ':,+.rte^': i .1TAc FoitmA omi V s - d ,u -' w a `mss 3 r a' ` _..., <.,,.��,......_.. .. ._x�..-:.S, s,'k�Y�,�`l�•_1�� „`.�atDfo-k--•m`" rY..�":��.,.�,.&�3-_."e OWNER NAME: Claremont Village Station LLC TENANT BUSINESS NAME(If Commercial): Vera Whole Health OWNER MAILING ADDRESS: STREET 11501 Northlake Dr cin. Cincinnati STATE OH ZIP 45249 OWNER PHONE: OWNER EMAIL: .. .,.r. CONTRACTOR NAME: Bergelectric Corp CONTRACTOR ADDRESS: STREET3182 Lionshead Ave cry Carlsbad STATE CA ZIP 92010 CONTRACTOR PHONE:425-251-3276 CONTRACTOR EMAIL:ayurchenko@bergelectric.com CONTRACTOR LIC.#(REQUIRED):BERGEC-021K6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):052176 "' PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) , ht CONTACT NAME: CONTACT PHONE:425-251-1132 Alex Yu rch en ko CONTACT EMAIL:ayurchenko@bergelectric.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 1 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. C of Everett Official Use Onl PERMIT#: (,w 9/26/19 E - Owner/Authoriz Age t Signature Date (Revised 1/11/2019) Page 1-Application