1920 100TH ST SE 2021-12-13 - Laserfiche WebLink

ow Im EVERETT 0 6 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 I eAvw.everettvra.gov/peri-r,il,-� PROJECT SITE INFORMATION PROJECT ADDRESS: 1920 1 00th St SE Bldg A IBUILDING AREA: 1,492 -sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION D ADDITION :1/1 TENANT IMPROVMENT El REMODEL BUILDING USE: ❑ SFR !,71 TOWNHOUSE 1:1 DUPLEX El ADu EIMULTI-FAMILY - # OF UNITS:_ F COMMERCIAL ELECTRICAL APP11CATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 43,000 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: Tenant improvement project for future medical clinic. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO YES - Select Scope: 0 service [7 Feeder Rj Circuits-#: 20 ❑ Complete Re -wire LOW VOLTAGE WORK? 7V NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): El Data El Intercom M Thermostat rl Audio El 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, 17 Other (List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO V 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: 7NO []YES -See Below & Pg, 3 Pursuant to RCW 19,28,26 1, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease F� 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: Sea Mar Community Health Cent' TENANT BUSINESS NAME (if Commercial): Sea Mar Everett Medical Clinic OWNER MAILING ADDRESS: STREIT 1040 S. Henderson St c,T, Seattle STA-E WA 98 108 OWNER PHONE: 206-763-5277 1OWNER EMAIL: CONTRACTOR NAME: Sterling Electrical Contractors CONTRACTOR ADDRESS: ITIIET6925 216th St SW Suite K ciTy LynnWood STATE WA Zip 98036 CONTRACTOR PHONE:425-774-1903 1CONTRACTOR EMAIL:aaron@secseattle.com CONTRACTOR LIC. #(REOUI RED): STERLEC859MS ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 60456 PRIMARY CONTACT: EOWNER ZCONTRACTOR E'OTHER (Please Specify) CONTACT NAME: Catht-, War -a' y CONTACT PHONE: 425-774-1903 CONTACT EMAIL: rathy.w@secseattfe.com AL2K=Mtr1V 1: 1 neracy canny that i have read and examined this application and RnOW the same to be true and Correct. All provisions offaws 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 ",)rk for which application is made and I comply with the State Contractors Law 18,27RCINand296.200 WAC. City of Everett Official Use Only PER----v,IT T 2-Co� c4S Owner/Atijhorized Agent Sig ature Date (Revised' lill/2019) Page I -Application