7600 EVERGREEN WAY EVERETT CLINIC 2022-02-03

ELECTRICAL PERMIT APPLICtION EVERETT WASHINGTON 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 7600 Evergreen Way BUILDING AREA: Unknown sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY-# OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & °DESCRIPTION OF W, CONTRACT PRICE OF WORK: $ 1000 ASSOCIATED BUILDING PERMIT # (if applicable): N/A DESCRIBE SCOPE OF WORK: Extend 2 circuits, add 9 new receptacles. DECO Project #EC19116 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 2 ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: El 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: TENANT BUSINESS NAME If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Dutton Electric Company, Inc. CONTRACTOR ADDRESS: STREET 12407 Mukilteo Speedway Suite A-170 CITY Lynnwood STATE WA ZIP 98087 CONTRACTOR PHONE: 425-347-7600 CONTRACTOR EMAIL: chaze@duttonelectric.com CONTRACTOR LIC. #(REQUIRED): DUTTOEc137P3 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 019811 PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Brad Morin CONTACT PHONE: 425-409-4854 CONTACT EMAIL:brad@duttonelectric.com muricctvicty t. i hereby certify Thar i have read and exammea tnts appucatton 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 / 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 WAC. City of Everett Official Use Only otgita➢y signed by Chaze Prayer PERMIT #: DN C-U5, E=chaze@duttonelectrie.com, Re Dutton Electric Comp any Inc", Chaze PrayerE ' ^ O� CN=Chaze Prayer �L{' Reasgn'. I am the author o/ this document bate 202001.09114021-0e'00• 1/9/2020 %.1/'_/'�■/w\) Owner/Authorized Agent Signature Date (Revised 1/1112019) Page 1-Application