2930 MAPLE ST 2023-04-28 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHING IoN (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov l vwmeverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2930 Maple St. Everett, WA 98201 BUILDING AREA: 50,000 sq ft PROJECT TYPE. ❑ NEW CONSTRUCTION ❑ ADDITION ❑TENANT IMPROVMENT WI REMODEL BUILDING USE: ❑ SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ✓❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $ 17735 ASSOCIATED BUILDING PERMIT#(if applicable) DESCRIBE SCOPE OF WORK: Replace 1 80A circuit breaker with 50A, relocate 1 receptacle and replace a large junction box for Remodel of X-Ray room in the radiology department 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: SELECT SCOPE(REQUIRED): ❑ Data El Intercom ❑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):SOW-Replace a breaker and move a receptacle. CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: Ll NO ✓ YES--See Below&Pg. 2 a 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: ❑NO ❑YES-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: Kaiser Permanente TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTRE-L1 2930 Maple St ,y Everett S-A,EWA Z,, 98446 OWNER PHONE:425-261-1500 OWNER EMAIL: CONTRACTOR NAME: Danard Electric, Inc CONTRACTOR ADDRESS: sTREei 18819 38th Ave E `,-y Tacoma ST:.-�: WA 98446 CONTRACTOR PHONE:253-875-8650 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):DANARE1136KG CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 62019 PRIMARY CONTACT: ::]OWNER []CONTRACTOR [-]OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-875-8650 HALEY MASBRUCH CONTACT EMAIL:HaleyM@danardelectric.com AGREEMENT I hereby erffy tri 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 c pleted w the specified herein or not. The granting of a permit does not presume to give authority to violate or tante!the provisions of any orier state or local law re ons. c6o 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/ comp th the tat Contra ,ors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only / PERMIT# 11/2312021 Own !Authorized ent Signature Date (Revised 1/11/2019) Page 1-Application