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NM
<br /> Bag ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET,EVERETT.WA 98201
<br /> WA St.o.,( TON (2)425-257-8810 I FAx 425-257-8857 I(E)everetteps@everettwagovi www everettwa goy/permits
<br /> PROJECT SI '- ISPOWTIOR, ,, ,•,,, ,,,,i,,,,,,,„is,,,
<br /> PROJECT ADDRESS: 4603 Riverfront Blvd BUILDING AREA: sq ft
<br /> PROJECT TYPE: E./.1 NEW CONSTRUCTION El ADDITION Li TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: V SFR 7 TOWNHOUSE El DUPLEX 0 ADU Li MULTI-FAMILY-#OF UNITS. El COMMERCIAL
<br /> l'‘,13YrttAa, ±; , : !:,, , :,„;,„ : .,;.Li:. ,,,,,„ja,,,F.:2. i ,.0:4.kg4f0PV:32lW
<br /> CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 100 amp temp power lot 310
<br /> —
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? CI NO El YES-Select Scope: El Service 0 Feeder 0 Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO 0 YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED): El Data El Intercom El Thermostat El Audio El Secure Access El Security System
<br /> El Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional
<br /> Fire Alarm Permit is required for review of device location and installation approval.
<br /> E Other(List All):
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: a NO ' YES--See Below&Pg,2
<br /> _.....
<br /> By checking this box, I am stating that I have read and understand all of WAC 29646B-900,selected the specific reason on page 2
<br /> of this application(see next page) AND Plan Review is NOT required because I meet all of the following sub sections that do not
<br /> See Page 2 require Plan Review.
<br /> ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ZNO OYES-See Below&Pg.3
<br /> Pursuant to RCW 1918.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale. or lease
<br /> without the proper electrical licensing and certification,or exemption.By checking this box,I am stating that I have completed and
<br /> See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement,
<br /> : air,iaZeM'c:,.AtitirrtitS,;r,;;A4g7V'NNg.
<br /> OWNER NAME: Polygon Homes TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTRgET 11624 SE 5th St Ste 100
<br /> crn, Bellevue STATE WA ztp 98005
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Garner Electric WA LLC
<br /> CONTRACTOR ADDRESS: STREET402 Valley Ave NW Ste 106
<br /> crne Puyallup sTATE WA 2, 98371
<br /> CONTRACTOR PHONE:253-872-6051 CONTRACTOR EMAIL:agentele@gweusacorn
<br /> CONTRACTOR LIC,#(REQUIRED):GARNEEW864KB CITY OF EVERETT BUSINESS LIC.tt(REQUIRED): 052909
<br /> PRIMARY CONTACT: FlOWNER WirICONTRACTOR flOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:253-278-7064
<br /> Paul Vantol CONTACT EMAIL:pvantolagweusa.com
<br /> AGREEMENT I hereby certify that!have read and examined this application and know the same to be true and correct. A!!provisions of laws and ordinances governing this
<br /> 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
<br /> local law regulating constru0tion or
<br /> the per/077,c:of construction That I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW ano 296.200 WAG. City of Everett Official Use Only
<br /> ,
<br /> , PERMIT#:
<br /> 8/20/2019 E
<br /> Owner ;utho:zed •ge ,pfn. tire Date (Revised 1/11/2019) Page 1-Application
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