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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-9810 I FAX 425257-8857 (El everetteps@everettwa,gov I www everettwagovipermits <br /> wssemo-r5s <br /> , ge:Atia,TE-777,711'.. NFO MAT ON <br /> PROJECT ADDRESS: 4610 Riverfront Blvd BUILDING AREA: sq ft <br /> PROJECT TYPE: NEW CONSTRUCTION El ADDITION 0 TENANT IMPROVMENT 0 REMODEL <br /> BUILDING USE: C-14 SFR El TOWNHOUSE El DUPLEX L ADU r-L_JI <br /> MULTI-FAMILY-#OF UNITS, 17 COMMERCIAL <br /> ."!5"..Y° ELECTIE Armpit INFORMATION & DESCRIPTION O1 WORK <br /> CONTRACT PRICE OF WORK:$ 250 1ASSOCIATED BUILDING PERMIT#tif applicable): <br /> DESCRIBE SCOPE OF WORK: <br /> 100 amp temp power <br /> Lot 376 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? [ZI NO El YES-Select Scope. Service El Feeder El Circuits-#: Complete Re-wire <br /> LOW VOLTAGE WORK? Zi NO El YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data El Intercom C] Thermostat CI Audio 0 Secure Access 0 Security System <br /> 0 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 /> 7 Other(List At) <br /> CODE COMPLIANCE <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH ANDIOR PERSONAL CARE FACILITIES: NO YES--See Below&Pg 2 <br /> By checking this box,i am stating that I have read and understand all of WAC 296-468-900,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:[ZINO OYES-See Below&Pg.3 <br /> — Pursuant to RCW 19.28261, 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 /> •,,,,,izr'YVt:':'‘V.040.•,!u•.',. ' <br /> CONTACT oRmknott <br /> OWNER NAME: Polygon Homes TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srtsar 11624 SE 5th St Ste 100 <br /> crt-y Bellevue WA 98005 <br /> OWNER PHONE. OWNER EMAIL' <br /> CONTRACTOR NAME: Garner Electric WA LLC <br /> CONTRACTOR ADDRESS: steser402 Valley Ave NW Ste 106 <br /> civf Puyallup WA 98311 <br /> CONTRACTOR PHONE:253-872-6051 CONTRACTOR EMAIL:agentele@gweusa corn <br /> CONTRACTOR LIC,*REG)UIRED)-GARNEEW864KB CITY OF EVERETT BUSINESS LIC.tt RI-al/REM 352909 <br /> PRIMARY CONTACT t DOWNER OCONTRACTOR IIOTHER(Please Specify) _ <br /> CONTACT NAME: CONTACT PHONE:253-278-7064 <br /> Paul Vantol CONTACT EMAIL:pvantol@gweusa.com <br /> 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 <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 construction or_the performance of construction That!am authorized by the owner of this property to perform the work for which application is made and <br /> comply with7M . e-Corifra&ors Law,16.27 RCW and 295.200 WAC City of Everett Official Use Only <br /> PERMIT#: <br /> 9/24/2019 E VIO9 (cS <br /> OwneriAuthortze Agent 5nature Date (Revised 1/11/2019) Page 1-Application <br />