1321 COLBY AVE 2ND FLOOR 2022-01-26

va ELECTRICAL PERMIT APPLICATION CITY OF EVFRETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits - PRtJT sibj# PROJECT ADDRESS: 1321 0_0L 9 f A- - ° BUILDING AREA: s9 ft PROJECT TYPE: 0 NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT REMODEL �1 BUILDING USE: ❑ SFR TOWNHOUSE ❑ DUPLEX Lj ADU ❑ MULTI -FAMILY - # OF UNITS:. ® COMMERCIAL xc __ fCar!ON CONTRACT PRICE OF WORK: $ ASSOCIATED BUILDING PERMIT # (if ap licabl : DESCRIBE SCOPE OF WORK: Tti+st*cL tp a VE�t7 Er G43'i`r9,%A" 8�q oo Qt-�A�Iz rruCt,�.��• � A��T THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? E NO YES - Select Scope: ❑ Service 1� Feeder �� Circuits-* Complete Rewire rt_�att LOW VOLTAGE WORK? ❑ NO YES- # of Devices: SELECT SCOPE (REQUIRED): E: Data 0 Intercom ❑ Thermostat Audio F Secure Access ✓W] 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): IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES NO 14 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 rage 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: NO YES -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 nave completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensingicertific.ation requirement_ ''- ^w'F"`�y.. .: ¢ :: �y• ..u'I.i 's'S •• 7777 -.V© OWNER NAME: Providence Medical Center TENANT BUSINESS NAME (if Commercial): OWNER MAILING ADDRESS: s,,,,T P.O.BoX 1067 CITY Everett s,ATE WA Z1P 98206 OWNER PHONE:425-261-3913 OWNER EMAIL: CONTRACTOR NAME: Aronson Security Group CONTRACTOR ADDRESS: STREET600 Oakesdale Avenue SW, Suite 100 CITY Renton 57ATE WA ziQ 98057 CONTRACTOR PHONE: 206-284-3553 CONTRACTOR EMAIL:. paul.aronson@aronsonsecurity.com CONTRACTOR LIC. #(REQUIRED):ARONSSG013C6 CITY OF EVERETT BUSINESS L.IC. #(REQUIRED): 031987 PRIMARY CONTACT: C]OWNER CONTRACTOROTHER (Please Specify) - CONTACT NAME: Pau( Aronson CONTACT PHONE: 206-245-1441 CONTACT EMAIL:pawl.arOnson@aronSOnsecurity.COm __.__.:_ _ A e a c ha fn,v anrt rnrrac All nrovsions of jaws and ordinances governing this AGREEMENT. l 1;ereby certify that ! have reac ana examrr,eau al- l,N,,;:a„ 11 an „ow ,— ..N.,, �- ..-_ - •- __.. ___ _ , type of work will be completed whether specified herein or not. The granting cf a permit does not presume to give authority to violate or cancel,, e prcvis,,ons of any other state or local law regulating construction or the performance of construction. That !am authonzed by the owner of this property to perform the work for which application is made and ! comply with the State Contractors Low 18.27 R)W and 296,200 WAC. PERMIT #: City of Everett Official Use -Only .Owner r/Authorized Amara Signature Date (Revised 1/1 SC1019) Page'VApplication