4201 RUCKER AVE COMMUNITY HEALTH CENTER 2023-05-23

OLT 1./ECTRICAL PERMIT APPLaTION 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.everettwa.gov/permits PROJECT ADDRESS: 4201 Rucker Ave BUILDING AREA: 25,236 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT El REMODEL BUILDING USE: ❑ SFR El TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL ELECTR14AL APP €O1+1' # tATIO tES /0N CONTRACT PRICE OF WORK:$ 4500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Connecting 1 Internally Illuminated LED Monument Sign and 2 Internally LED Illuminated Wall Signs to existing 20 amp dedicated circuits. 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? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data Cl Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ 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):Connecting 1 Internally Illuminated LED Monument Sign and 2 LED Internally Illuminated Wall Signs 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: ✓❑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. OWNER NAME: Community Health Center Of Snip,' TENANT BUSINESS NAME(If Commercial): Community Health Center of Snohomish County OWNER MAILING ADDRESS: STREET 8609 Evergreen Way CITY Everett STATE WA ZIP 98208 OWNER PHONE:Tyler Ciena (425) 789-3781 OWNER EMAIL: tciena@chcsno.org CONTRACTOR NAME: Fastsigns Everett/ Electrical: Apex Sign Co. LLC CONTRACTOR ADDRESS: STREET 6214 Rockefeller Ave CITY Everett STATE Wa ZIP 98203 CONTRACTOR PHONE:Christopher Sheflo(503)380-1630 CONTRACTOR EMAIL:ApexSignCOLLC@hotmail.com W 4 o 14 CONTRACTOR LIC.#(REQUIRED):EC APEXSSC7811 D CITY OF EVERETT BUSINESS LIC.#(REQUIRED):604897204 PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-438-9350 Harminnie Berger CONTACT EMAIL:harminnie.berger@fastsigns.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#: Harminnie Berger V/l ' E 226e7-O M Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application