10821 19TH AVE SE PNW PHYSICAL THERAPY 2019-07-25

ELECTRICAL PcRMIT & FIRE ALARM P MIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits dmf iO fe ifiVa n,, 0.1 r.n 2,,0 �tf (OrEn- *. � �',zW;titti .k .F `;;;,' „ri'. '� , xPROf*I z,,M.7 IT, A, I OI�MATION • :,:;:i,11,:•,==,..•%: •:. PROJECT ADDRESS: 10821 19th Ave SE, #102 PROJECT TYPE: n NEW CONSTRUCTION ADDITION 0 TENANT IMPROVMENT REMODEL BUILDING USE: F SFR 0 TOWNHOUSE 0 DUPLEX 0 ADU 0 MULTI-FAMILY-#OF UNITS: {a COMMERCIAL BUILDING AREA: 2200 sq ft x ; ' ' Et:tOTtildAL A klib Th10N INFQRNikeit N CONTRACT PRICE OF WORK: $ 12987 ASSOCIATED BUILDING PERMIT#(if applicable): IS THIS LOW VOLTAGE WORK? 0 NO ❑YES-#OF DEVICES: IS THIS A FIRE ALARM PERMIT? 12 NO 0 YES-Plans required for review(Both Electrical and Fire Department inspections are required) r 'lQ `DESCRIPTION OF WORK & CODE COMPLIANCE' DESCRIPTION OF WORK: Tenant Improvement-Job#57923 18 receptacles, 4 dedicated receptacles, 1 Hot water tank, 15 lights, 4 switches THIS SECTION APPLIES TO ALL EDUCATION, INSITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: FBy 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. ATTENTION OWNERS: THIS SECTION IS FOR OWNERS PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ® 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 signed the See Page 3 AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT 41NOCOMAIION OWNER NAME: TENANT BUSINESS NAME(If Commercial): PNW Physical Therapy OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pride Electric, Inc. CONTRACTOR ADDRESS: STREET 18133 NE 68th St, D-120 clrY Redmond STATE WA ZIP 98052 CONTRACTOR PHONE: 425-454-3665 'CONTRACTOR EMAIL: mbender@prideelectric.com CONTRACTOR LIC.#(REQUIRED): PRIDEEI077DR CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 027137 PRIMARY CONTACT: D OWNER CONTRACTOR [OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-454-3665 Matt Bender CONTACT EMAIL: mbender@prideelectric.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/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# Owner/Authorized Agent Signature Date (Revised 10/30/2018) Page 1 of 3