1321 COLBY AVE 3RD FLOOR 2022-01-26

•EVE TT WASHINGTON EI$CTRICAL PERMIT APPLICV,TION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 i FAX 425-257-8857 1 (E) everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 321 Colby Avenue, Everett, WA BUILDING AREA: 1400 scl ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: ❑✓ COMMERCIAL ELECTRICALAPPLICATIONINFORMATION & °DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 66,000 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: The scope of this project is the remodel of an existing segment of the C-Wing third floor. The remodel will expand the existing pharmacy space. Work includes the demolition and installation of lighting, power, and low -voltage commodities. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 16 ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Devices: 13 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: D NO ✓ 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: [:]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 licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Providence Regional Medical C TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 1321 Colby Avenue CITY Everett STATE- WA ZIP 98201 OWNER PHONE: 425-218-0919 OWNER EMAIL: James.Grafton@providence.org CONTRACTOR NAME: to be determined (, �w r L & r L_L CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): L T Z� I) CITY OF EVERETT BUSINESS LIC. #(REQUIRED): ® Cj PRIMARY CONTACT: DOWNER []CONTRACTOR ❑✓ OTHER (Please Specify) Jack Glover CONTACT NAME: Jack Glover CONTACT PHONE: 206-354-3123 CONTACT EMAIL: jack.glover@stantec.com A(1fft=outcry t: i here oy cerury that t nave read and examined tuts application and know the same to be true and correct. All provisions of laws and ordinances governing 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 I 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 1 a27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: E 21 2 02-17-2021 (� Owner/Autho: zed Agent Signature Date (Revised 1/1112019) Page 1-Application