12902 19TH AVE SE GENUINE SMILE DENTISTRY 2021-02-23

• • IIIIIm• ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits t �p ,:; PROJECT SITE INFORMATION:" PROJECT ADDRESS: 12902 aettTUIPtSweitihmy Suite E Everett,WA 98208 BUILDING AREA: 1,479 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ®TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ©COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 34,964 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK:Tenant Improvement of existing dental clinic,addition of new lights and receptacles. 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? ® NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ©YES--See Below&Pg.2 L ,Jfi 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 re 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: Lee Northwest Investments LLC TENANT BUSINESS NAME(If Commercial): Dr.Jade Gan OWNER MAILING ADDRESS: STREET POBox997 CITY Snoqualmie STATE WA ZIP 98065 OWNER PHONE: 425-888-2993 OWNER EMAIL: NA CONTRACTOR NAME: Lunstrum Electric Inc CONTRACTOR ADDRESS: STREET 15372 Juanita Dr NE cur Kenmore STATE WA ZIP 98028 CONTRACTOR PHONE: 206-930-0057 CONTRACTOR EMAIL: peter@lunstrumelectric.com &sarah@tunetrumelectrlc.com CONTRACTOR LIC.#(REQUIRED): LUNSTEI882NH CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 53442 PRIMARY CONTACT: EOWNER ®CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Peter Lunetrum CONTACT PHONE: 206-930-0057 CONTACT EMAIL: peter@lunstrumelectric.comI sarahCiunstrumelectric.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#: ' 10/29/19 E A \ 0 - N(i0 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application