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tLECTRICAL PERMIT APPLICATION OLTCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits tick ', PROJECT ADDRESS: 1 700 1 3th Street, Everett, WA. 98201 BUILDING AREA: 68,955 _ sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ....EL! C C ►L APPLICATION INFORMAro,I & ESC I` t N f WORD CONTRACT PRICE OF WORK: $ 64,350.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Job# 832341 . DDC connections for supply and exhaust valve installation. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? El NO EYES-#of Devices:95 SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ©Thermostat ❑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): CODE1i 11PUANCE1 _ R IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO f1 YES--See Below&Pg.2 By checking , I I nnof -4 - 0,selected the specific reason on page 2 u of this applicationthisbox(seeam next pagestating )that,ANDhave Planread Reviewaduis NOTderstand requiredall WAC because296 I meet 90all 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: ENO DYES-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 I'N ORMA "I#... . .. ...... *._ ,: 714 OWNER NAME: Providence Hospital TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1700 13th Street c,T,, Everett STATE WA ZIP 98201 OWNER PHONE:425-261-2000 OWNER EMAIL: CONTRACTOR NAME: EC Electric CONTRACTOR ADDRESS: STREET 981 Powell Ave SW CITY Renton STATE WA zip 98057 CONTRACTOR PHONE:206-356-0730 'CONTRACTOR EMAIL:Chris.Moeller@ecpowerslife.com CONTRACTOR LIC.#(REQUIRED):ECCOM**148BA (CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 051774 PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR EOTHER(Please Specify) CONTACT NAME: ECONTACT PHONE:206-356-0730 Chris Moeller CONTACT EMAIL:Chris.Moeller@ecpowerslife.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 ERlig#Chris Moeller 5/6/19 ` Of✓-�J - 09S Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application