1321 COLBY AVE 2ND FLOOR 2022-01-26

RECTRICAL PERMIT APPLATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: - 1700 13th St IBUILDING AREA: sa ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL CONTRACT PRICE OF WORK: $ 20,000.00 JASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Installation of EMCS/DDS system wiring THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 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 wiring rough -in of the system. An additional Fire Alarm Permit is required for review of device location and installation approval. ✓❑ Other (List All): HVAC IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: U NO I✓_I YES -- See Below & Pg. 2 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 MYES -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. OWNER NAME: PRMCE TENANT BUSINESS NAME (If Commercial): Colby Pharmacy OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Datskiy Electric CONTRACTOR ADDRESS: STREET1908 Island View PL CITY Anacortes STATEWA zi, 98221 CONTRACTOR PHONE: 360-941 -4754 1CONTRACTOR EMAIL: leo.d U@datskiyelectrlc.Com CONTRACTOR LIC. #(REQUIRED): DATSKEL820JT CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 60268 PRIMARY CONTACT: DOWNER QCONTRACTOR [:]OTHER (Please Specify) CONTACT NAME: CONTACT PHONE:360-708-8677 Ivan Datskiy CONTACT EMAIL:ivan.d@datskiyelectric.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 oovernina 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/ am authorized by the owner of this property to perform the work for which application is made and / comply with the State Contractors Law 18.27 RCW and 296.200 WA City of Everett Official Use Only PERMIT #: E Y: Owner/Authorized Agent Signature Date (Revised 111112019) Page 1-Application