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

At-ECTRICAL PERMIT APPLI TION 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 1 3th St, Everett WA 98021 IBUILDING AREA: 20,000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TQ NHOU ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL RACT PRICE OF WORK:($ 260,000.00 / JASSOCIATED BUILDING PERMIT # (if applicable): A---,l 'I r) -J, _ DESCRIBE SCOPE OF WORK: Telecom cablinq on thelg&ff6or speaker cablinq 9th floor THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:48ELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑ YES - Selec co e: ❑ Se ice ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Devi es: 400 SELECT SCOPE (REQUIRED): ✓❑ Data ❑ Intercom ❑ Ther ostat ✓❑ Audio ❑ Secure Access ❑ Security System ❑ Fire Alarm - Installations u is 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: U NO L✓I 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: WINO OYES -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: Providence Med Center Everett TENANT BUSINESS NAME If Commercial): OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW #9016 ,T, Renton STATE WA ZIP 98057 OWNER PHONE:452 261-2000 OWNER EMAIL: NA CONTRACTOR NAME: Veca Electric and Tech CONTRACTOR ADDRESS: STREET 5610 7th ave S CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE: 206 436-5200 CONTRACTOR EMAIL: mike.battistoni@veca.com CONTRACTOR LIC. #(REQUIRED): VECAEET821OO CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 004948 PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 206 794-8852 Ben Lutkov ICONTACT EMAIL: Ben.Lutskov@veca.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 governinq 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: Mike Battistoni 9-10-19 I ` nCA , C(� Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application