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• <br /> LT. ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa gov1 winiw.everettvva.gov/pemlits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: a oLg AUC, S JBUILDING AREA: soft <br /> PROJECT TYPE: NEW CONSTRUCTION -1 ADDITION ri TENANT IMPROVMENT IA REMODEL <br /> BUILDING USE: H SFR 7 TOWNHOUSE HI DUPLEX Li ADU LI MULTI-FAMILY-#OF UNITS-_. _ *COMMERCIAL <br /> ELECTRICAL APPIAAVKiN INFORMATION& DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK:$ JASSOCIATED BUILDING PERMIT <br /> DESCRIBE SCOPE OF WORK: 3"U67014,1., Lott) Sizau.etry rSifik 3i 5C, <br /> 0;L, Pw_A kinAcy <br /> tpt... .65 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? L NO 7 YES-Select Scope' E Service 7 Feeder 7 Circuits-#: Li Complete Re-wire <br /> LOW VOLTAGE WORK? C NO II YES-#of Devices' g <br /> SELECT SCOPE(REQUIRED). F.7 Data Li Intercom 1-1 Thermostat 7 Audio El Secure Access Security System <br /> Eli Fire Alarm-Installations under this permit only include electrical wiring rough-In of the system.An additional <br /> Fire Alarm Permit is required for review of device location and installation approval. <br /> El Other(List All):__ <br /> ---- <br /> , CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: j NO 5./1 YES--See Below&Pg. 2 <br /> 1". 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 <br /> of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not <br /> See Page 2 require Plan Review, <br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: riiNC) DYES-See Below&Pg.3 0, <br /> Pursuant to RCW 19.28.261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease <br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and <br /> see page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. <br /> tC5114A51. INFORMATION <br /> OWNER NAME: Providence Medical Center TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET P.O.Box 1067 <br /> CITY Everett STATE WA ZIP 98206 1 <br /> OWNER PHONE:425-261-391 3 OWNER EMAIL: <br /> CONTRACTOR NAME: Aronson Security Group <br /> CONTRACTOR ADDRESS: smnr 600 Oakesdale Avenue SW, Suite 100 <br /> cit-y Renton STATE WA La 98057 <br /> CONTRACTOR PHONE:206-284-3553 CONTRACTOR EMAIL:paid.aronson©aronsonsecurity.com <br /> CONTRACTOR LIC.#(REQUIRED):ARONSSG013C6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 031987 <br /> PRIMARY CONTACT: HOWNER 14CONTRACTOR DOTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-245-1441 <br /> Paul Aronson CONTACT EMAIL:pauLaronson@aronsonsecurity.corn <br /> AGREEMFAIT t hereby celery that I have read and examined this application and know the same to be true and correct. Al/provisions of laws and Ordinances governing this <br /> 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 <br /> tonal law regulating construction or the performance of construction. That I am authorized by the owner of this property to peifonn the won,for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296 200 WAC. City of Everett Official Use Only <br /> PER-MIT#' <br /> Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application <br />