916 PACIFIC AVE BASE FILE 2021-12-10

• • ELECTRICAL PERMIT & FIRE ALARM 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 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:916 PACIFIC AVENUE PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ©REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ©COMMERCIAL BUILDING AREA: sq ft ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$750 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? ❑✓ NO ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? ©NO ❑ YES-Plans required for review(Both Electrical and Fire Department Inspections are required) DESCRIPTION OF WORK & CODE COMPLIANCE DESCRIPTION OF WORK: Load bank testing of 3 emergency back up generators 190664 1903665 1903663 IS THIS PERMIT EDUCATION,INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: ©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 1 I 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:C.INO EYES-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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: Providence health and services TENANT BUSINESS NAME(If Commercial): Providence OWNER MAILING ADDRESS: STREET916 PACIFIC AVENUE- Hospital Pacific Campus cm, Everett STATE WA zip 98201 OWNER PHONE:253.395.9077 OWNER EMAIL:anokes@pacificpowergroup.com CONTRACTOR NAME:Pacific Power Group CONTRACTOR ADDRESS: sTREET805 Broadway Street,#700 cnr Vancouver STATE WA zip 98660 CONTRACTOR PHONE:253-395-9077 CONTRACTOR EMAIL:anokes@pacificpowergroup.com CONTRACTOR LIC.#(REQUIRED):EC PACIFPG867D& CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053000 PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-395-9077 Amanda Nokes CONTACT EMAIL:anokes@pacificpowergroup.com AGREEMENT:1 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 ownor 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 WA C. City of Everett Official Use Only PER # o , LioL9 � emu horized Agent Signature Date (Revised 11/5/2018) Page1-A I 9 9 pp Ication