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

ELECTRICAL PERMIT APPLIION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits Vi4 apt Qi PROJECT SITE INFORMATION PROJECT ADDRESS: 1 2902 Sethelt Everett Hwy Suite E 98208 BUILDING AREA: 1500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION &DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 5000.00 ASSOCIATED BUILDING PERMIT#(if applicable). DESCRIBE SCOPE OF WORK: Run 19 Cat 6 Low voltage cable THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 19 SELECT SCOPE(REQUIRED): ✓❑ Data ❑ Intercom ❑Thermostat El 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. El Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: T-;1 LvJ 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: Dr Jade Gan TENANT BUSINESS NAME(If Commercial): Dr Jade Gan OWNER MAILING ADDRESS: STREET 12902 Bothell Everett Hwy Suite# !l CITY Everett STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Synergy Communications CONTRACTOR ADDRESS: STREET6007 27th Ave NE CITY Seattle STATE WA ZIP 98115 CONTRACTOR PHONE:206 755-5122 CONTRACTOR EMAIL:hyung@syntechwa.com CONTRACTOR LIC.#(REQUIRED):SYNERCL881ca CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ; e PRIMARY CONTACT: ❑OWN ER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206 755-5122 H yu n g Kim CONTACT EMAIL:hyung@syntechwa.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#: 1- A E 10\‘2,- \10 Owner/Authors d Agen gnature Date (Revised 1/11/2019) Page 1-Application