1321 COLBY AVE 4TH FLOOR 2022-04-27

1112 EL CTRICAL PERMIT APPLIC'TION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 wasrt�uoTon+ (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@everettwa.gov I www.everettwa.gov/permits , ...« INFORMA1'IOW PROJECT ADDRESS: 1321 Colby Avenue, Everett WA 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL • E g t $ , ORM °� TIQNO ::. CONTRACT PRICE O WORK:$ \5�� !ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE O RK_ Installing Responder 5 nurse call in area 9D of Providence Regional. THIS INSTALLATION INCLUDES THE FOLLOW OPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ES-Select Scope: El Service ❑ Feeder El Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ N ❑✓ YES-#of Devices:180 SELECT SCOPE (REQUIRED): ❑ D to ❑ Intercom jieTrthepti CI Audio CI Secure Access CI Security System ❑ Fire larm-Installationmit only include electrical wiring rough-in of the system.An additional Fire Alarm e - -required for review of device location and installation approval. ❑✓ Other(List All):Nurse call system l7 YS ANCM IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO ✓ YES--See Below&Pg.2 I 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: ONO 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. • OWNER NAME: TENANT BUSINESS NAME(If Commercial): Providence Regional Med Cent OWNER MAILING ADDRESS: STREET 1321 Colby Avenue, Everett WA 98201 Everett STATE WA zip 98201 OWNER PHONE:425-261-2000 OWNER EMAIL:customerservice@providence.org CONTRACTOR NAME: Electrocom CONTRACTOR ADDRESS: sTREET6815 216th Street SW CITY Lynnwood STATE WA ZIP 98036 CONTRACTOR PHONE:425-562-7796 CONTRACTOR EMAIL:gendel@eleCtrOCOm.US CONTRACTOR LIC.#(REQUIRED):ELECT**137DP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):035221 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360_522-6976 Pete Hanson CONTACT EMAIL:peteh@electrocom.us 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 PERMIT#:ER Pete Hanson, Installation Coordinator 07/26/2019 ` v `cA — Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application