1700 13TH ST 9TH FLOOR 2022-01-20

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 1 www.everettwa-gov/permits PREJEtT SITS'->�EO[Ilfi#Tt#_. PROJECT ADDRESS: 1-700 ( 1 V 1ep, e- T scl ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: COMMERCIAL ELLS iil?F�t..:.!t101 iI ..'itI.,: CONTRACT PRICE OF WORK: $ 3 qpq q ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: 'i.��rA�c Lp vp'-T 0R iTi f FIST l 192 11 Ccs_K,/ qn, r'txoe &_. C I- + OOZ *P s {DL. •. �l�C�c�(�i T l C� iill� �i f F 47` THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? D NO ❑ YES -Select Scop ery ce ❑ Feeder ❑ Circuits-#: _ ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Device . 24 rr--11 SELECT SCOPE (REQUIRED): ❑ Data ❑i Intercom ATermos ❑ 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): t >: zt IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: NO ✓ YES -- See Below & Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 29646B-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 DYES -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 aapplicatiion to receive an exemption from this licensinglcertification requirement. OWNER NAME: Providence Medical Center TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET P•O.BOx 1067 �,n, Everett SATE WA 1,98206 OWNER PHONE: 425-261-3913 OWNER EMAIL: CONTRACTOR NAME: Aronson Security Group CONTRACTOR ADDRESS: STRE-_T600 Oakesdale Avenue SW, Suite 100 a c,ry Renton STATE: WA Z,, 98057 ) CONTRACTOR PHONE.206-284-3553 CONTRACTOR EMAIL: paul.aronson@aronsonsecurity.com CONTRACTOR LIC. #(REQUIRED): ARONSSG01 3C6 ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 031987 PRIMARY CONTACT: [-]OWNER ZCONTRACTOR []OTHER (Please Specify) CONTACT NAME: Aronson Paul i 1 Aronson ... PHONE:206-245-1441 CONTACT EMAIL. paul.aronson@aronsonsecurity.com j .. .. .. .. ..__ ._ ,__ ._._ __� __....-s au :..,.•,�;.. ..rl ws anrd orrlinannes nrniaminn this AGREEMENT: 1 hereby certify that I have read and examined this appncanon ano know inc swino w Lc +u& ai,u v„� .. ,,.. .• _--- _.._ _. _---__-_ 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 l comply with the State Contractors Law 18.27 RCW and 296.200 WAC City of Everett Official Use Orrfy PERMIT #: