1321 COLBY AVE 2ND FLOOR 2022-01-26

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits S'C'r ..FQi� PROJECT ADDRESS: 132 1 �(, gy l� Vo . BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT W REMODEL .BUILDING USE: ❑ SFR ❑ TOWNHOUSE ® DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: H COMMERCIAL E .ECTR CA' :APPPCAT1Ei�101FOR A' IQI�1 DESCR PT �1.+QF;'PfiQR . CONTRACT PRICE OF WORK: $ 3 Lf j (o ASSOCIATED BUILDING PERMIT # (if licable DESCRIBE SCOPE OF WORK. INS-rpc- L©W ' ot_rA6.a trl S`V ,j1'I S - 1$-53 ram,, O 6AmIPv5-SuP-orQ.Y GotTjf CHf_x_0-1OK LUDO t7 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): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑✓, Security System ❑ Fire Alarm - Installations under this permit only include electrical wirfng 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: LJNO ✓ YES -- See Below & Pg. 2 121 By checking this box, I am stating that I have read and understand all of WAC 296-466.900, 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 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 have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this Iicensing/certification requirement. CONi't.[FdTib OWNER NAME: Providence Medical Center TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET P.o. BOX 1067 c,n Everett STATE • r` ` Z,, 98206 OWNER PHONE:425-261-3913 OWNER EMAIL: CONTRACTOR NAME: Aronson Security Group CONTRACTOR ADDRESS: sTREET600 Oakesdale Avenue SW, Suite 100 CITY Renton STATE WA ZIP 98057 CONTRACTOR PHONE:206-284-3553 1CONTRACTOR EMAIL: Paul.aronSon@aronsonseCUflty.com CONTRACTOR LIC. #(REQUIRED):ARONSSG013C6 CITY OF EVERETT BUSINESS LIC..#(REQUIRED): 031987 PRIMARY CONTACT: DOWNER ZCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Paul Aronson CONTACT PHONE:206-245-1441 CONTACT EMAIL:paul.aronson@aronsonsecurity.com yvrz vl�ly 1: 1 nefevy cemry mar i nave read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this ype 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 ocal 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 :omply with the State Contractors Law 18.27 RCW and 296.200 WAG. City of Everett Official Use Oniy PERMIT #: i 6u_e 1 :Z I E 16f1E, )�0 owner/Authorized Agent Signature Date (Devised 1/11/2019) Page 1-Fy{�plication 1 _