8530 EVERGREEN WAY FRED MEYER 2022-10-06

• • ELECTRICAL PERMIT APPLICATION %441 71 CITY OF EVERETT PERMIT SERVICES :*►' s.- 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everettepsteverettwa.gov l wAw.everettwa.gov/permits "7. fi —.r, '. > PROJEMITAIRi.E;i1NFORMATz!_ON :,, PROJECT ADDRESS: 8530 Evergreen Way BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION 0 ADDITION 0 TENANT IMPROVMENT Q REMODEL BUILDING USE: 0 SFR ❑TOWNHOUSE ❑ DUPLEX 0 ADU ❑MULTI-FAMILY-#OF UNITS: L✓ COMMERCIAL LECiritICC'ALIAPLPI IV TIONINFORIVIATIANii*DESCRIP' ONNOWNVORK__... CONTRACT PRICE OF WORK:$ 17,500 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Disconnect, relocate, reconnect(20) 120v circuits THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑NO D YES-Select Scope:❑Service 0 Feeder D Circuits-#:20 0 Complete Re-wire - LOW VOLTAGE WORK? ❑ NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): O Data ❑intercom Q Thermostat C Audio ❑Secure Access 0 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): I ,* ,0mx 0,4R xe Or i , - _... em,.. a C1CtiE�UMP»fANGe "� <�.»..', `-",, , y77,7. . -... �_.. ,.IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: III NO • YES—See Below&Pg.2 El 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:ONO OYES-See Below&Pg.3 E 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: Fred Meyer TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: smaaT 8530 Evergreen Way crry Everett STATE WA py 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: SeaTac Electric CONTRACTOR ADDRESS: sTREET7056 S 220th St CM Kent sTATE WA VP 98032 CONTRACTOR PHONE:2538725553 CONTRACTOR EMAIL:frani.schriner a@seatacelectric.com CONTRACTOR UC.#(REQUIRED):SEATAEI077RW JCITY OF EVERETT BUSINESS LIC.*REQUIRED):033037 PRIMARY CONTACT: DOWNER DCONTRACTOR DOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-638-7513 Frani Schriner CONTACT EMAIL: AGREEMENT::I hereby certify that t have mad 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 I, •- :.elating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and t co h the State Contractors Law 18.27 RCW and 296.200 WAC, City of Everett Official Use only PERMIT* 1 4 //14 /1f E \6 OL4 25 of erfAuthorized Agent Signature Date (Revised 1/11/2019) Page 1-Application