1800 41ST ST EVERETT CLINIC FRONTIER BUILDING 2020-02-25

AL PERMIT APPLiditiON CITY OF EVERETT PERMIT SERVICES EVERETT3200 CEDAR STREET,EVERETT«WA 98241 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I wvrw.everettwa.gov/permits :. Y 4 ,C„ PROJECT ADDRESS: 1800 41st Street Ste 5500 Everett, WA 98203 BUILDING sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION El ADDITION ®TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR 0 TOWNHOUSE El DUPLEX El ADU ❑MULTI-FAMILY-#OF UNITS: El COMMERCIAL 0 �a CONTRACT PRICE OF WORK:$ 500 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Added receptacles and minor lighting re-work. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO ®YES-Select Scope:❑Service ❑ Feeder ❑✓ Circuits-#:2 0 Complete Re-wire LOW VOLTAGE WORK? Q NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom El Thermostat 0 Audio 0 Secure Access El 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. El Other(List All): • IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO Q YES—See Below&Pg.2 By checking tttis box,I am stating that I have read and understand all of WAC 296-46B-9t}tl,selected the specific reason on page 2 .........of 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: ONO OYES-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 F. 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. ;, ® • ¢, �, OWNER NAME: TENANT BUSINESS NAME(If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET 1800 41st St Suite S500 city Everett STATE WA ziR 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Dutton Electric Company, Inc. CONTRACTOR ADDRESS: STREET 12407 tvlukilteo Speedway Suite A-170 CRY Lynnwood STATE WA DR 95057 CONTRACTOR PHONE:425-347-7600 CONTRACTOR EMAIL:info@duttonelectric.com CONTRACTOR LIC.#(REQUIRED):DUTTOEC137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):opsit PRIMARY CONTACT: DOWNER E]✓..CONT CTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-409-4854 BRAD MORIN CONTACT EMAIL:info@duttonelectric.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 l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: E \°I \Z Owner/Authorized Agent Signature D to (Revised 1/11/2019) Pagel-Application