2930 MAPLE ST KAISER PERMANENTE 2020-12-31

R.ECTRICAL 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 PROJECT ADDRESS: 2930 maple street everett wa 98201 BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ✓❑ REMODEL BUILDING USE: ❑SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION'INFORMATION & DESCRIPTION'OF WORK CONTRACT PRICE OF WORK:$ 23,800 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Support replacement and relocation of(5) split system HVAC Indoor and outdoor Units. Our scope includes relocation of a 60 amp branch circuit that feeds the outdoor equipment and a simple replacement of the indoor equipment. No increase in load. JOB NUMBER 1004796 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ✓❑ Feeder ❑✓ Circuits-#:11 ❑ 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): 1,- • CODE 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 296-46B-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. CONTACT INFORMATION OWNER NAME: Kaiser Permanente TENANT BUSINESS NAME(If Commercial): KP Everett Behavioral Health OWNER MAILING ADDRESS: STREET 2930 Maple Street Everett WA 98201 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Prime electric, INC CONTRACTOR ADDRESS: STREET 3460 161st ave ne CITY bellevue STATE wa ZIP 98008 CONTRACTOR PHONE:425.365.3235 CONTRACTOR EMAIL:madeline.popravak@primeelectric.com CONTRACTOR LIC.#(REQUIRED): PRIMEEI134BT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1994e PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ['OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.559.8811 FRANK HOLBERG 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#: Madeline Popravak ® E 1 at 12- 0°t6 pa .•< •_�� 12/13/2019 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application