916 PACIFIC AVE 2ND FLOOR 2025-06-30

E ECTRICAL PERMIT APPLE '%TION CITY OF EVERETT PERMIT SERVICES EVERETT WASHINGTON 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION;:", PROJECT ADDRESS: 916 PACIFIC AVE. IBUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION [A TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY -# OF UNITS: ❑✓ COMMERCIAL „ ELECTRICAL APPLICATION INFORMATION 4'DESCRIPTION OF;WORK , CONTRACT PRICE OF WORK: $ ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIBE SCOPE OF WORK: (6) LED RETROFIT IN EXISTING DIRECTORY MONUMENT SIGNS THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? [3NO ❑ YES - Select Scope: ❑ Service ❑ Feeder ❑ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? LV N0 EaYES-# of Devices: 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. Q Other (List All): ...:;. .. ',CO,DE.COMPLIANCE. 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 296-4613-800, 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. 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. - CONTACT .INFORMATION OWNER NAME: PROVIDENCE HEALTH `mac SER V TENANT BUSINESS NAME (If Commercial): PROVIDENCE REGIONAL MED ICAL CENTER OWNER MAILING ADDRESS: STREET 1801 LIND AVE SW #9016 Crrr RENTON - _. STATE WA zip 98057 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: THE SIGN POST CONTRACTOR ADDRESS: sTREET2019 E. BAKERVIEW RD. crrY BELLINGHAM STATE WA Z,p 98226 CONTRACTOR PHONE:360-671-1343 ICONTRACTOR EMAI:BRENNA@THE-SIGNPOST.COM CONTRACTOR LIC. 4(REQUIRED):SIGNPI*066PK CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 051261 PRIMARY CONTACT: DOWNER OCONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: LORIE BLUNT CONTACT PHONE:360-671-1343 CONTACT EMAIL:LORIE@THE-SIGNPOST.COM A(iHLLMLN 1: l nereby ceMly that 1 nave 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 spectFed 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/ am authorized by the owner of this properly to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: " I. ,, E 7 t .- l Z_ Authori 7 d Agehua6riature Dat (Revised 1/1112019) Page 1-Application