10318 EVERGREEN WAY WOODS COFFEE 2023-07-31

l>• ELECTRICAL PERMIT APPLIC ION 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 10312 Evergreen Way BUILDING AREA: sq ft PROJECT TYPE: ❑✓ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT El REMODEL BUILDING USE: ❑SFR El TOWNHOUSE El DUPLEX ❑ ADU ❑ MULTI-FAMILY-#OF UNITS: ElCOMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 400 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Connect (2) LED illuminated wall signs & (3) Drive Thru menu structures to power provided by others. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ✓❑ NO El YES-Select Scope: ❑ Service El Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ✓❑ NO ❑YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom El Thermostat El Audio El Secure Access El 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):Sign CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ✓❑ NO El 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: ENO EYES-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 Street Lynden STATE WA zip 98264 OWNER PHONE:360-393-7553 OWNER EMAIL:taylorh@woodscoffee.com CONTRACTOR NAME: Signs Plus Inc CONTRACTOR ADDRESS: STREET 766 Marine Drive c,Tv Bellingham STATE WA zliP 98225 CONTRACTOR PHONE:360-671-7165 CONTRACTOR EMAIL:permits@signsplusnw.com CONTRACTOR LIC.#(REQUIRED):SIGNSPI954LW CITY OF EVERETT BUSINESS LIC.#(REQUIRED):52728 PRIMARY CONTACT: DOWNER ['CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-671-7165 Royce Sieving CONTACT EMAIL:permits@signsplusnw.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#: Royce Sieving Digitally signed by Royce Sieving E ��O _ I4-3Date:20220614 11:09:19-07'00' Owner/Authorized Agent Signature Date (Revised 1/11/2019) / Page 1-Application