3625 BROADWAY STARBUCKS 2022-01-11

• az ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 998�220everettwa.9ov/Perm is WASHINGTON (P)425-257-6810 I FAX 425-257-8857 I(E)everetteps@everettwa. ov PROJECT SITE INFORMATION PROJECT ADDRESS: 3625 Broadway, Suite A, Everett WA 98201 (BUILDING AREA: 1U00 sq ft PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION ©TENANT IMPROVMENT ❑REMODEL BUILDING USE: 0 SFR E i TOWNHOUSE 0 DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL ELECtRICAL APPI qq 1CATION INFORMATION &DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 1500 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Remove current bathroom wall fixtures, install new Dyson hand dryer, terminate existing electrical outlets in restroom, install blank cover. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ©NO ❑YES-Select Scope:❑Service ❑Feeder ❑Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ©NO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑Data 0 Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System 0 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): >,,. .. .>CODE COMPLIANCE ,a„ IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: El NO ❑YES—See Below&Pg.2 flJ By checking this box,I am stating that I have read and understand all of WAC 296-4613-900,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 DYES-See Below&Pg.3 fl 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: TENANT BUSINESS NAME(If Commercial):Starbucks#8740 OWNER MAILING ADDRESS: STREET 3625 Broadway Suite A cm Everett STATE WA zip 98201 OWNER PHONE:425-252-4086 'OWNER EMAIL: CONTRACTOR NAME: Mastercraft Electric, Inc. CONTRACTOR ADDRESS: STREET206 Frontage Rd N cm' Pacific STATE WA ZIP 98047 CONTRACTOR PHONE:253-737-4367 CONTRACTOR EMAIL:garyd@mastercraftinc.com CONTRACTOR LIC.#(REQUIRED):MASTEE112789 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):055704 PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-295-0089 KIIm! 1 Darling CONTACT EMAIL:kimd@mastercraftinc.COm AGREEMENT:I hereby certify that I have road and examined this application and know the same to be true and correct. All provisions of laws and orctinances 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 1 comply with the ate Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT#: lAA'N " / E V:AAc _ ()q I Owner/Authorized Agen Signature to (Revised 1/11/2019) Page 1-Application Scanned with CamScanner