1700 13TH ST 3RD FLOOR 2022-05-16

ØECTRICAL PERMIT APPLSATIO. E� t1�� EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 21 ?r PR 1 /, 20 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.g p its FP I PROJECT SITE INFORMATION CITY OF EVERFTT PROJECT ADDRESS: 1 700 13th Street, Everett, WA BUILDING AREA: 820 Permit Services PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 180,749.00 ASSOCIATED BUILDING PERMIT#(if applicable): E2109-069 DESCRIBE SCOPE OF WORK: The scope of this project builds out a new EP Lab in a shelled space on the third floor of the D-Wing tower. Work includes installation of lighting, power, and low-voltage commodities. This application captures added load from the previously reviewed permit E210.9 D69- THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder 26 ❑ Circuits-#: CI Complete Re-wire LOW VOLTAGE WORK? ❑ NO ✓❑YES-#of Devices:34 SELECT SCOPE(REQUIRED): ❑✓ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: CI NO El YES--See Below&Pg. 2 l l 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: ENO EYES-See Below&Pg. 3 I I 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: Providence Regional Medical Cer TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1700 13th Street cmy Everett STATE WA ziP 98201 OWNER PHONE:314-817-7202 OWNER EMAIL:steven.falardo@providence.org CONTRACTOR NAME: Cochran, Inc. CONTRACTOR ADDRESS: STREET 12500 Aurora Ave North CITY Seattle STATE WA ZIP 98133 CONTRACTOR PHONE:206-367-1900 CONTRACTOR EMAIL:info@cochraninc.com CONTRACTOR LIC.#(REQUIRED):EC COCHRiOasJs CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5147 PRIMARY CONTACT: DOWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Electrical Engineer CONTACT NAME: CONTACT PHONE:661-406-1385 Nowell An ch eta CONTACT EMAIL:nowell.ancheta@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 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#: Pa 4/12/21 E DD3— (LcA Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application