900 PACIFIC AVE AUTISM 1ST FLOOR 2025-12-02

mll 112 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.govIwww.everettwa.gov/permits 4,NP,Abblottaffri- 4:10':' FROJECTALTE INFORMATION' , ', A. ;12-? PROJECT ADDRESS: '"O 10th 3t =!verett, WA 98201 BUILDING AREA: 2000 sq ft PROJECT TYPE: LI NEW CONSTRUCTION ❑ADDITION ❑TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ,44 . ELEOTRucA .N 1pR ICATiON INFORMATIO N DESCRIPTION O W RKM. ...; it,: I' CONTRACT PRICE OF WORK:$ 140,000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: The scope of this project is the remodel of an existing segment of the first floor. This includes the demolition and installation of lighting, power, and low-voltage commodities. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑Service ❑ Feeder ❑✓ Circuits-#:3° ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:45 SELECT SCOPE(REQUIRED): ❑✓ Data ❑ Intercom ❑Thermostat ❑Audio ✓❑Secure Access ❑ Security System 0 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): ram: , COD OMPLIANCE r:. IS THIS PERMIT EDUCATION,INSTITUTIONAL,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 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: LINO 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. 7 t'' CONTsM__ A . r i r OWNER NAME: Providence Regional Medical Cer TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1321 Colby Avenue cry Everett STATE WA ZIP 98201 OWNER PHONE:425 218-0919 OWNER EMAIL:James.Grafton@providence.org CONTRACTOR NAME: To be determined CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): -.. . ,, ,.' .-. ,„ . - . - ,-, .. . - PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓OTHER(Please Specify) Jack Glover CONTACT NAME: CONTACT PHONE:206 354-3123 Jack Glover CONTACT EMAIL:jack.glover@stantec.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 performs 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 Cont tors Law 18.27 nd 296.200 WAC. City of Everett Official Use Only s PEERRMIT#: ` (� ,,� --A — a-- 01-29-2021 ` ` `-' ` Owner! th9fzed Agent Signature Date (Revised 1/11/2019) Page 1-Application e