10318 EVERGREEN WAY WOODS COFFEE 2023-03-30

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everelteps@everettwa.gov I www.everettwa.gov/perm PROJECT SITE INFORMATION PROJECT ADDRESS: 10318 Evergreen Way BUILDING AREA: 671 sq ft PROJECT TYPE: ❑✓ NEW CONSTRUCTION ❑ ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: Z✓ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 15,000 ASSOCIATED BUILDING PERMIT # (if applicable): B2111-024 DESCRIBE SCOPE OF WORK: Electrical service and distribution per plan THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES - Select Scope: ❑ Service ❑✓ Feeder ❑✓ Circuits-#: ❑ Complete Re -wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES- # of Devices: 3 SELECT SCOPE (REQUIRED): W1 Data ❑ Intercom 0 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. ❑✓ Other (List All): drive thru communication CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓ NO Ll YES -- See Below & Pg. 2 a By checking this box, I am stating that I have read and understand all of WAC 296-466-900, 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 ❑ 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: TAYLOR HERMAN TENANT BUSINESS NAME (if Commercial): WOODS COFFEE OWNER MAILING ADDRESS: STREET 191 18TH ST ,,, LYNDEN STATE WA ZIP 98264 OWNER PHONE: 360.393.7553 OWNER EMAIL: TAYLORH@WOODSCOFFEE.COM CONTRACTOR NAME. VALLEY PLUMBING AND ELECTRIC CONTRACTOR ADDRESS: STREET 910 W FRONT ST CITY SUMAS STATE WA ZIP 98295 CONTRACTOR PHONE: 360.988.9631 CONTRACTOR EMAIL: Jason@valleype.com CONTRACTOR LIC. #(REQUIRED): VALLEPE15l13n4 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 61888 PRIMARY CONTACT: ZOWNER []CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: Taylor Herman CONTACT PHONE:360.393.7553 CONTACT EMAIL: taylorhCcbwoodscoffee.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 corn /eted whether specifier/ 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 co truction or the performance of construction. That Ian) authorized by the owner of this property to perform the work for which application is made and/ comply with the St at ontractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT #: Z, (:�'z q.), t JE Owner! uj orized Agent Signature bate (Revised 111112019) Page 1-Application