4614 RIVERFRONT BLVD 2020-07-02 - Laserfiche WebLink

MIN LI 4CTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET%EVERETT.WA 98201 NA/Aswan-row (11)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everattwagov 1 uvww.evereltwagov/permits PROJECT ADDRESS: 4614 Riverfront Blvd BUILDING AREA: sq ft PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT 0 REMODEL BUILDING USE: EZl SFR 0 TOWNHOUSE El DUPLEX 0 ADU El MULTI-FAMILY-#OF UNITS. E COMMERCIAL t't ''.iiiiritIsagrt -iiii.Iriliii ii..ii•ai.;,‘"i'''i: 11011114rT.,..iat;i7-it:,14.1.41:41. ,,i4.::.1,:iifiVIlift. ' CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable). DESCRIBE SCOPE OF WORK: 100 amp temp power lot 374 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO El YES-Select Scope:0 Service 0 Feeder E Circuits-#: 0 Complete Re-wire LOW VOLTAGE WORK? 0 NO 0 YES-#of Devices: SELECT SCOPE(REQUIRED): 0 Data 0 Intercom ID Thermostat LI Audio 0 Secure Access 0 Security System El 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. El Other(List All): tiiitiiiiX.Z.C.:72MICal: IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 12 NO a YES—See Below&Pg,2 i I By checking this box,I am stating that I have read and understand all of WAC 2964613-900,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: [Z]NO EYES-See Below&Pg. 3 L...... 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 1.039 ''.;gA'i'fLaj7gr-'!;V:jllbiRl'V .:;,:,s'Z‘-.5,,EATAL:hairnit7..4: 1:4i„. "1111Wiiii:714,MER.Witivit,7;*.M4V OWNER NAME: Polygon Homes TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 11624 SE 5th St Ste 100 crty Bellevue STATE WA z„, 98005 OWNER PHONE: [OWNER EMAIL: CONTRACTOR NAME: Garner Electric WA LLC CONTRACTOR ADDRESS: STREET 402 Valley Ave NW Ste 106 CITY Puyallup STATE WA 98371 CONTRACTOR PHONE:253-872-6051 CONTRACTOR EMAIL:agentele©gweusa.com CONTRACTOR LIC.#(REQUIRED):GARNEEW864KB 1CITY OF EVERETT BUSINESS LIC.#(REOUIRED): 052905 PRIMARY CONTACT: Elf7OWNER 171CONTRACTOR EOTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-278-7064 Paul Vantol CONTACT EMAIL:pvantol@gweusascom •AGREEMENT:I hereby cent&that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing inn 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 dt any other state or local law regulating construction 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 I comply with =,'State Contractors Law 1027 RCW and 296.200 WAC City of Everett Official Use Only 4 ‘t Ind Agen ,fignature Date 12019 PERMIT ft: E lot Dot - 0 0 art iCO (Revised 1111/2019) Page 1-Application