2930 MAPLE ST KAISER PERMANENTE 2024-12-05

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 l(E)everetteps@everettwa.gov I wwmeverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2930 Maple Street BUILDING AREA: 46,000 sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION [—]ADDITION ❑✓ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEx ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ©COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 43,450.00 1ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Relocating receptacles and adding (8) new receptacles onto existing circuit as well as (8) new data outlets. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? ❑ NO ❑✓ YES-Select Scope: ❑ Service ❑ Feeder 0 circuits-#:5 ❑Complete Re-wire LOW VOLTAGE WORK? ❑ NO ❑✓ YES-#of Devices:8 SELECT SCOPE(REQUIRED): ❑✓ Data ❑ 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): CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO ✓ 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; ©NO EIYES-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 licensingicertification requirement. CONTACT INFORMATION OWNER NAME: Kaiser FOUndtion Health Plan TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2930 Maple Street c,n Everett STATE WA Z,P 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME. Danard Electric, Inc CONTRACTOR ADDRESS: STREET 18819 38th Ave E cny Tacoma STATE WA Z,p 98446 CONTRACTOR PHOfVE:253-875-8650 CONTRACTOR EMAIL:HaleyM@danardelectria.com CONTRACTOR LIC.#(REQUIRED): DANARE1136KG CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 62019 PRIMARY CONTACT: DOWNER OCONTRACTOR []OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-720-8648 Haley Masbrueh CONTACT EMAIL:HaleyM@danardelectric.com AGREEMENT:thereby certify that l hav a 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 wheth specifi d herein ornot. 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 const he perfo ante of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and/ comply with the S7577741/17/20 WAC. City of Everett Official Use Only PERMIT#: E •"` Owner/Authorize gent Si t e Date (Revised 1/1112019) Page,-Application