1321 COLBY AVE 4TH FLOOR 2022-04-27

• • OLT ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everetiwa.gov/permits PROJECT SI? 'E fiNFQ1�141>> TIION PROJECT ADDRESS: 132( Ctot_a,f AV E BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑TENANT IMPROVMENT 01 REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: gi COMMERCIAL E .ECTRIC/ L APPLICATION I$ OR TION &'iR? SEI PTION O i R!_fc CONTRACT PRICE OF WORK:$ 1,00 I ASSOCIATED BUILDING PERMIT# if aaolicable): DESCRIBE SCOPE OF WORK: TikiST74i4- got-E4.GE S4ST— /yl q._i?g61 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓ NO ❑ YES-Select Scope: ❑Service ❑ Feeder ❑Circuits-#: C Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices: 9-- SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat El Audio 0 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. ❑Other(List All): copE GE L ANcE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: CI NO El YES--See Below&Pg.2 1.77By 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 V 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: ZNO 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: Providence Medical Center TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET P.O.Box 1067 C17y Everett • STATE WA ZIP 98206 OWNER PHONE:425-261-3913 OWNER EMAIL: CONTRACTOR NAME: Aronson Security Group CONTRACTOR ADDRESS: STREET600 Oakesdale Avenue SW, Suite 100 CITY Renton - STATE WA ZIP 98057 CONTRACTOR PHONE:206-284-3553 ,CONTRACTOR EMAIL:paul.aronson@aronsonsecurity.Com CONTRACTOR LIC.#(REQUIRED):ARONSSG013C6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 031987 PRIMARY CONTACT: DOWNER ✓❑CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-245-1441 Paul Aronson CONTACT EMAIL:pau[.aronson@aronsonsecurity.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 l 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#: r2ckAe_(,tt--------- .z.;—r9 E \.ot 3 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application