220 OLYMPIC BLVD VA OUTPATIENT CLINIC 2023-01-26

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@overettwa.gov I www.everettwa,gov/permits PROJECT $ATE INFQRIMA7fI4N PROJECT ADDRESS; 220 Olympic Blvd, Everett WA 98203 IBUILDING AREA: 29,066 sq ft PROJECT TYPE: ® NEW CONSTRUCTION ❑ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULT(-FAMILY-#OF UNITS; COMMERCIAL ELECTRICAL Al p1:.. ' WI TIQk� SC I Tto h WORK CONTRACT PRICE OF WORK:$ 1,094,850,00 ASSOCIATED BUILDING PERMIT#(if applicable): B2101-007 DESCRIBE SCOPE OF WORK: 2 Story Ground Up VA Medical Clinic with new 800A 480V 3P Electrical Service, Lighting, Lighting Cntrls Electrical Connections to Plumbing and HVAC Equipment, Power Receptacles amd Misc Medical Equipment. Scope includes various LV systems per below. Scope to include Temp Construction Service. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ®YES-Select Scope:m Service ® Feeder ®Circuits-#:300 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ®YES-#of Devices:600 SELECT SCOPE(REQUIRED): m Data ® Intercom ❑ Thermostat m Audio ® Secure Access ® Security System m 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): COR.. C;tD. LSA OW"; IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES; 0 NO L1 YES See Below&Pg.2 ❑ By checking this box, I am stating that I have read and understand all of WAC 296-468-900,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 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. CO+ITACT I > �1 RMIA I•IO OWNER NAME: Catalyst Capital TENANT BUSINESS NAME if Commercial): VA CBOC - Everett WA OWNER MAILING ADDRESS; STREET 1554 N. Beverly Drive My Beverly Hills STATE CA Z,, 90067 OWNER PHONE:Mike Cocco 484-547-5530 1OWNER EMAIL;mcaccO@catalystcap.com CONTRACTOR NAME: Northstar Electrical, LLC CONTRACTOR ADDRESS: STREET PO BOX 1909 ,,Ty Bothell STATE WA zlp 98041 CONTRACTOR PHONE:206-329-1596 1CONTRACTOR EMAIL:adamc@northstar-electrical.com CONTRACTOR LIC.#REQUIRED:NORTHEL878QF ICITY OF EVERETT BUSINESS LIC.#REQUIRED: 052744 PRIMARY CONTACT: DOWNER OCONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-786-2983 Adam Chudoba CONTACT EMAIL:adamc@lorthstar-Slectrical.com AGREEMENT:l hereby certify that t 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 specifled 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 296.200 WAC. City of Everett Official Use Only PERMIT°�#: � Adam ChUdob�- Ck--- 1114/21 E � c o 4 Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application