405 SE EVERETT MALL WAY 2021-11-02

i • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASH INGTON (P)425-257-8810 I FAX 425-267-8857 I(E)everetteps@everettwa.gov I www.everetlwa.gov/permits PROJECT ADDRESS: 405 SE Everett Mall Way Everett, WA 98208 BUILDING AREA: 1°7,895 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION 0 ADDITION El TENANT IMPROVMENT 0 REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL CONTRACT PRICE OF WORK:$-•,215 Sj i ASSOCIATED BUILDING PERMIT#(if applicable): lei SA D2.r A5' DESCRIBE SCOPE OF WORK: ELECTRICAL CONTRACTOR TO DISCONNECT AND REMOVE ANY EXISTING ELECTRICAL DEVICES IN AREA INDICATED. UTILIZE EXISTING CIRCUITS TO FEED NEW REFRIGERATED CASES. REMOVE ANY UNUSED CIRCUITS BACK TO LAST ACTIVE SOURCE. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO ✓ YES-Select Scope:❑Service ❑ Feeder Q Circuits-#:5 El Complete Re-wire LOW VOLTAGE WORK? Q 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. Q Other(List All): UTILIZE EXISTING CIRCUITS TO FEED NEW REFRIGERATED CASES IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO D 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: ©NO OYES-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: TENANT BUSINESS NAME(If Commercial): Target#0337 OWNER MAILING ADDRESS: STREET Target 50 South 10th Street,suite 400, CITY Minneapolis STATE MN ZIP 55403 OWNER PHONE;612-761-6788 OWNER EMAIL:Matthew.Flansburg@target.com CONTRACTOR NAM r: TBD kfA/V0 1C01• S A IA:1 1 CONTRACTOR ADDR : STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): (� I,1 S V s itG).1Z.T CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 443 g1.. PRIMARY CONTACT: DOWNER ❑CONTRACTOR ✓OTHER(Please Specify) IUrolsy-Hen CONTACT PHONE:(206)-800-1889 CONTACT NAME:Taylor Bel lefeu llle CONTACT EMAIL:Taylor.Bellefeuifle@kimley-hom.com AGREEMENT!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 f am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only PERMIT#: 2/17/2021 E 21 o2-r1 (0 Owne nze gent Signature Date (Revised 1/11/2019) Page 1-Application