3726 BROADWAY BASE FILE 2020-08-27

ELECTRICAL PERMIT APPLICA i ION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3726 BROADWAY #206 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX Cl ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 2300 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 3 BATTERY POWERED BACK UP LIGHTS- 1 IN EACH OF 2 OPERATING ROOMS, 1 IN ROOM NEXT TO OR's THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ✓❑YES-Select Scope: ❑ Service ❑ Feeder ✓❑ Circuits-#:6 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ 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: THERAPUETIC HEALTH SERVICES TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 9930 EVEREGREEN WAY Z-100 CITY EVERETT STATE WA ZIP 98203 OWNER PHONE:360.547.3188 OWNER EMAIL: CONTRACTOR NAME: EYLANDER SALES & SERVICE CONTRACTOR ADDRESS: STREET3601 EVERETT AVE CITY EVERETT STATE WA z,P 98201 CONTRACTOR PHONE:425.259.2161 CONTRACTOR EMAIL:1Ceylander@yahOO.COITI CONTRACTOR LIC.#(REQUIRED):EYLANSS142LP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):016363 PRIMARY CONTACT: DOWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) CONTACT NAME: I C TOO CONTACT PHONE:425.231.2275 CONTACT EMAIL:)Ceylander@yahoo.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 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#: /124/1„,_ /1,,_ /1 .2-- 7 E \CI l \ (.2b Own Authorized Agent Signature Dat (Revised 1/11/2019) Page 1-Application