8530 EVERGREEN WAY FRED MEYER 2022-10-06

MINN • 112 ELECTRICAL PERMIT APPLILATION 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 PROJECTOld:':•, : •4 PROJECT ADDRESS: 8530 EVERGREEN WAY, EVERETT BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑COMMERCIAL C _ 1. P CICATI RMATI ES CONTRACT PRICE OF WORK:$ 1,000 (ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install (1) 20amp 120V dedicated circuit for Vending Machine. WO# 48221 TIM WILLIAMSON 206-406-4123 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑✓ Circuits-#: 1 ❑ Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED) ❑ Data ❑ Intercom El Thermostat Cl Audio ❑Secure Access ❑ 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. ❑✓ Other(List All): CODE C _ 1• SEJ IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: PA 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: EINO DYES-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. CONTA .:. PR OWNER NAME: FRED MEYER TENANT BUSINESS NAME(If Commercial): FM EVERETT OWNER MAILING ADDRESS: STREET 8530 EVERGREEN WAY CITY EVERETT STATE WA Z,P 98208 OWNER PHONE:425-348-8400 OWNER EMAIL: CONTRACTOR NAME: COCHRAN INC CONTRACTOR ADDRESS: STREET 12500 AURORA AVE N CITY SEATTLE STATE WA ZIP 98133 CONTRACTOR PHONE:206-368-1900 CONTRACTOR EMAIL:JBBROWN@COCHRANINC.COM CONTRACTOR LIC.#(REQUIRED):COCHRI'o88Js CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19558 PRIMARY CONTACT: ❑OWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-406-4123 TIM WILLIAMSON CONTACT EMAIL:TWilliamson@cochraninc.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 PERMIT#: JECINA BROWN.,COCHRAN INC 8-1-19 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application