10025 19TH AVE SE 201 EVERETT DENTAL CLINIC 2023-12-28

Ili ELECTRICAL PERMIT APPLICATION 1� CITY OF EVERETT PERMIT SERVICES E V E R E T T3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I(E)PermitServices@everettvia.gov I =,vw.everettwa.gov/permits WAFNINOTON PROJECT SITE INFORMATION PROJECT ADDRESS:10025 19th AVE SE, Suite 201, Everett, WA 98208 BUILDING AREA: 1456 sq ft 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:$500 ASSOCIATED BUILDING PERMIT#(if applicable):B2108-072 DESCRIBE SCOPE OF WORK: Run Ethernet Cables (Cat6/7)from router location to Ethernet endpoints. Run Ethernet Cables (Cat6/7)from router location to Ethernet endpoints. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope:❑Service ❑Feeder ❑Circuits-#: ❑Complete Re-wire LOW VOLTAGE WORK? ❑NO ❑✓ YES-#of Devices:20 SELECT SCOPE(REQUIRED): Z 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): CODIE""COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: L NO LVJ YES--See Below&Pg. 2 By checking this box, I am stating that I have read and understand all of WAC 296-466-900,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 DYES-See Below&Pg. 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. v.._ CONTACT INFORMATION. OWNER NAME:SURIeet Mittal TENANT BUSINESS NAME If Commercial):Everett Smiles OWNER MAILING ADDRESS: sTREEr10025 19th AVE SE, Suite 201 Everett STATE WA ZIP 98208 OWNER PHONE:7327542952 1OWNER EMAIL:Sippymittal@gmail.COm CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:7327542952 Sumeet Mittal 1CONTACT EMAIL:sippymittal@gmailcom 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 vA#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/ comply with the State Contractors Law 98.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#. OwnerlAuthorized Agent Signature Date (Revised 4/5/2022) Page 1-Application