1130 SE EVERETT MALL WAY HOME GOODS 2023-06-22

V ELECTRICAL PERMIT APPLIITION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I(E)PermitServices@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1130 SE EVERETT MALL WAY, Suite D BUILDING AREA: 24000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ❑✓ TENANT IMPROVMENT ❑REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: El COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK: $12000 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: FIRE ALARM TENANT IMPROVEMENT PER PLAN. INSTALL (1) REMOTE POWER FIRE ALARM TENANT IMPROVEMENT PER PLAN. INSTALL (1) REMOTE POWER SUPPLY AND (20) OCCUPANT NOTIFICATION DEVICES 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:21 SELECT SCOPE(REQUIRED): ❑Data ❑Intercom ❑Thermostat ❑Audio ❑Secure Access ❑Security System ElFire 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: ❑✓ NO L 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:LINO EYES-See Below& Pg. ❑ 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:TJX COMPANIES TENANT BUSINESS NAME(If Commercial): HOME GOODS OWNER MAILING ADDRESS: STREET770 COCHITUATE RD FRAMINGHAM STATE MA Z,P 01701 OWNER PHONE:817.521.2917 OWNER EMAIL: CONTRACTOR NAME:FIRE PROTECTION INC CONTRACTOR ADDRESS: STREET PO BOX 12642 CITY BOTHELL STATE WA zp 98203 CONTRACTOR PHONE:425.290.9600 CONTRACTOR EMAIL:DAVID@FPISEATTLE.COM CONTRACTOR LIC.#(REQUIRED):FIREPI*021 ML CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 038814 PRIMARY CONTACT: DOWNER ECONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: DAVID MOW CONTACT PHONE:425.290.9600 CONTACT EMAIL:DAVID©FPISEATTLE.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 o tthe 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 Statp..Cdntractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only -"� PERMIT#: 12/28/22 E Owner/Authorized Agent Signature Date (Revised 4/5/2022) Page 1-Application