3020 RUCKER AVE SNO CO HEALTH DISTRICT 2021-12-20

■� . . ® ELECTRICAL PERMIT APPLICATION 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 3020 Rucker Ave, Everett, WA 98201 BUILDING AREA: 5000 sq ft PROJECT TYPE: El NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR El TOWNHOUSE ❑ DUPLEX ❑ADU El MULTI-FAMILY-#OF UNITS: Q✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1200.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Add elevator recall per site request. Includes elevator recall required addressable relays • THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope:El Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? El NO ❑✓ YES-#of Devices:2 SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑Thermostat El Audio El Secure Access El Security System El 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):Elevator CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: LWJ NO El YES--See Below&Pg.2 By checking this box, I am stating that I have read and understand all of WAC 298-46B-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 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 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: Shawn Frederick TENANT BUSINESS NAME(If Commercial): Snohomish Health District OWNER MAILING ADDRESS: STREET 3020 Rucker Ave, Suite#308- C CITY Everett STATE WA ZIP 98201 OWNER PHONE:425-339-5203 OWNER EMAIL: CONTRACTOR NAME: Fire Protection Inc CONTRACTOR ADDRESS: STREET 17410 Ash Way, Ste 8 CITY Lynnwood STATE WA ZIP 98037 CONTRACTOR PHONE:425 290 9600 CONTRACTOR EMAIL:Megant@fpiseattle.com CONTRACTOR LIC.#(REQUIRED):FIREPI*ML CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 038814 PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425 290 9600 Megan Vaughn CONTACT EMAIL:megan@fpiseattle.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 try 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 PERMIT#: (r4.(‹A ()Litir 02 13 2020 E ` C \ O Owner/Autlpor zed',Vent Stature Date (Revised 1/11/2019) Page 1-Application