3927 RUCKER AVE BASE FILE 2025-12-12

i EECTRICAL PERMIT APPLICATION 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 ,= PROJECT SITE INFORMATION '., 16,:' 4 ,i;,. PROJECT ADDRESS: 3927 Rucker Ave BUILDING AREA: unknown sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR [ 617V—Nk1OUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL ELEC IGAL PPUCATION INFORMATION &DESCRIPTION:of WORK c „. :...fit CONTRACT PRICE OF WORK:$ 500 ASSOCIATED BUILDING PERMIT#(if applicable): N/A DESCRIBE SCOPE OF W 'RK: Extend 1 circuit, install new receptacle. DECO Project#EC2001 THIS INSTALLATION INCLUDES THE 1 LO NG SCOPE: (SELECT ALL THAT APPLY) �� LINE VOLTAGE WORK? ❑ N ❑✓ Y Select Scope: ❑Service ❑ Feeder ❑✓ Circuits#: ❑ Complete Re wire LOW VOLTAGE WORK? ✓❑ Ni, ❑ ES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Da Intercom ❑Thermostat El Audio El Secure ccess El 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. El Other(List All): t5„ ,---$1,,o CODE COMPLIANCE .f, IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El 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 1/ 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 ❑ 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. m .: , : .. . 'IN ORMA,TION C.ONTJ�IC,„. " P OWNER NAME: TENANT BUSINESS NAME(If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Dutton Electric Company, Inc. CONTRACTOR ADDRESS: sTREET 12407 Mukilteo Speedway Suite A-170 CITY Lynnwood STATE WA ZIP 98087 CONTRACTOR PHONE:425-347-7600 CONTRACTOR EMAIL:chaze@duttonelectric.com CONTRACTOR LIC.#(REQUIRED):DUTTOEC137P3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019811 PRIMARY CONTACT: DOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-409-4854 Brad Morin CONTACT EMAIL:brad@duttonelectric.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 DMCy SEeda zcZeuPonyercccom, PERMIT#: 0=•Dotton Electric Company,Inc", Chaze Prayer Da ..,orarayer E `2 Cc)( Reason.I am the author of this document \ lQ oate�zozo oi.,a fa:aas�-oe'oo' 1/14/2020 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application