1005 PACIFIC AVE 2019-07-08 - Laserfiche WebLink

!LECTRICAL PERMIT APPLIL-TION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits -... . , by, ,:.EVk_... ._ >.r,. PROJECT SITE iNIK RMATIOM ,` t..? .> :_..'_. . ER PROJECT ADDRESS: 1005 Pacific Avenue BUILDING AREA: 500 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION 0 TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ✓Q COMMERCIAL ,,,' i .._...._ „ ` ,tELECTRICAL APPLICATION,INPORMAIROPMDEsc IP' IQN{OP WORK`S _.. IS CONTRACT PRICE OF WORK:$ 1000.00 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Relocating lighting, relocating switch and adding receptacles. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑Service ❑ Feeder ❑✓ Circuits-#:2 ❑Complete Re-wire LOW VOLTAGE WORK? ❑✓ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): Cl 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): 4,t r, `.....V tg..CODE COMPLIANCE ,inaua , '., ` esm ., 3 y 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: ONO EYES-See Below&Pg.3 UPursuant 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. SDKUNSMVOMMiggiaacaSen"..CORTAVEINfORMATIONOMMOBSIBMOSISSOONBAN OWNER NAME: TENANT BUSINESS NAME(If Commercial): Puget Sound Kidney Center OWNER MAILING ADDRESS: STREET 1019 Pacific Avenue CITY Everett STATE WA Zip 98201 OWNER PHONE:425.259.5195 OWNER EMAIL: CONTRACTOR NAME: Pro-Tech Electric, Inc CONTRACTOR ADDRESS: STREET 1126 Bonneville Ave CITY Snohomish STATE WA zip 98290 CONTRACTOR PHONE:425.334.9844 CONTRACTOR EMAIL:Tbentem@pro-techelectric.com CONTRACTOR LIC.#(REQUIRED):PROTETE934JC CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 055041 PRIMARY CONTACT: [DOWNER ❑✓CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.334.9844 Taylor CONTACT EMAIL:Tbentem@pro-techelectric.com AGREEMENT:I hereby certify that!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 A JJ PERMIT#: /(/� PaMtill.42420. 5/8/2019 E V4O V -0 1 Owner/Authorized Agent Signature..................................... .. ..Date.................................................. .............................(Revised 1/11/2019)......................Page 1-Application..