1700 13TH ST 2020-08-28 - Laserfiche WebLink

ELL'UTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 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 PROJECT SITE',INPORMATION PROJECT ADDRESS: 1700 13th St Everett, WA 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑✓ ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: El SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL AP ' + � , CONTRACT PRICE OF WORK:$ 3500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: n 3 OR Room controls and 4 VAVs Vl)\ � � ') THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO El YES-Select Scope: ❑ Service ❑ Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices:1 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑Thermostat El Audio El 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):4 vays CODE COMPLIANCE . IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO 0 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: LINO 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. CON; INFO OWNER NAME: Providence Hospital TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Datskiy Electric CONTRACTOR ADDRESS: sTREET1908 Island View PL CITY Anacortes STATE WA ZIP 98221 CONTRACTOR PHONE:36O-420-7657 CONTRACTOR EMAIL:eduard.d@datskiyeleCtric.com CONTRACTOR LIC.#(REQUIRED):DATSKEL820JT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60268 PRIMARY CONTACT: ❑OWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-420-7657 Ed CONTACT EMAIL:eduard.d@datskiyelectric.corn 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#: E )G 0'1 212 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application )