4027 HOYT AVE BASE FILE 2021-09-07

E ECTRICAL PERMIT APPLICTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits y x. 'PROIlECT SITE INFORMATION �...;, PROJECT ADDRESS: 4027 Hoyt Ave BUILDING AREA: 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 WORK CONTRACT PRICE OF WORK:$ 1000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Retrofit (2) exam room lights and (1) light switch. DECO Project #EC19102. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: El Service ❑ Feeder ✓❑ Circuits-#:1 ❑ Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED) ❑ Data ❑ Intercom ❑ Thermostat El 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 COMPL"MANCE '" IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ❑ NO U YES--See Below& Pg.2 ✓ By ch , I am stating that have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 of this applicationecking thisbox(see next page),AlND 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 application to receive an exemption from this licensing/certification requirement. r . CONTACT INFORMATIONN' 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 DCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-409-4854 Brad Morin CONTACT EMAIL:brad@duttonelectric.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 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 18.27 RCW and 296.200 WAC. City of Everett Official Use Only ai ; Wcmzeweer PERMIT#' C Prayer .e e�oueeaati�m°om E i/� _ (�///��l T6E�0rMeM M CN Cnaze Rayar " � I y "1 eCM1 9ree109565,S803 ra or Ms mcumenl 1 0...2051250 9565<.Od OJ 1 vzsn s Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application