2930 MAPLE ST KAISER PERMANENTE 2019-11-06

`I ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT$ITE INFORMATION PROJECT ADDRESS: 2930 Maple Street Everett WA 98201 BUILDING AREA: outside no measurable SQ FT sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFRRi+ CI TOWNHOUSE CI DUPLEX CI ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL ELECTR C ISA ION• FOi R ATI ,DES. RIP:T NO WOR •• . ..'; CONTRACT PRICE OF WORK: $ 3160 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install circuit for Pedestal Sign and control connection. JOB 6007172 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder E✓ Circuits-#: 1 ❑Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#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. ❑Other(List All): �w �a'tn.? r' •r �. ! -f71�\,„ 40% NCIG IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO L 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: ENO 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. OWNER NAME: Kaiser Permanente TENANT BUSINESS NAME(If Commercial): Kaiser Permanente OWNER MAILING ADDRESS: STREET 2930 Maple Street CITY Everett STATE WA ZIP 98201 OWNER PHONE:206-658-5279 OWNER EMAIL:Randy.E.Olsen@kp.org CONTRACTOR NAME: PRIME ELECTRIC INC. CONTRACTOR ADDRESS: STREET3460 161st Ave SE CITY Bellevue STATE WA ZIP 98008 CONTRACTOR PHONE:425-747-5200 CONTRACTOR EMAIL:Permits@Primeelectric.com CONTRACTOR LIC.#(REQUIRED):PRIMEEI134BT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19946 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-559-8811 Kevin Bolger CONTACT EMAIL: 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 PERMIT#: i7 gita y signed by Ryan Junt E (�}�!!!^''' 1/'p� pN>C=US,E=ryan.junn Junt eelectnacom,O=Prime I D5 i \1 L Eleatic Inc.,OU=Purchasing,CN=Ryan Junt Date: 010.Oi.16 11:11.26 0700' Owner/Aul torized Agent Signature Date (Revised 1/11/2019) Page 1-Application