Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> N (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> WASifiGTON <br /> 'NEOT R7.0017aaa-nliMP144Mir'' <br /> PROJECT ADDRESS: 4621 31st Ave SE 'BUILDING AREA: sq ft <br /> PROJECT TYPE: El NEW CONSTRUCTION El ADDITION TI TENANT IMPROVMENT El REMODEL <br /> BUILDING USE: V SFR El TOWNHOUSE El DUPLEX Li ADU El MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> • <br /> CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable). <br /> DESCRIBE SCOPE OF WORK: <br /> 100 amp temp power lot 348 <br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) <br /> LINE VOLTAGE WORK? D NO 0 YES-Select Scope:El Service 0 Feeder El Circuits-#: El Complete Re-wire <br /> LOW VOLTAGE WORK? El NO CI YES-#of Devices: <br /> SELECT SCOPE(REQUIRED): El Data ED Intercom 0 Thermostat El Audio 0 Secure Access D 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 /> D Other(List All): <br /> :0%011140N::' <br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: PA NO al 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: ONO OYES-See Below&Pg. 3 <br /> I-1 Pursuant to ROW 19.28.261,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 /> '4,2,Zartalikl.ZILLYIETtiffflIVZ*TAggrZ*14.*Silk4iiir' • :.• <br /> OWNER NAME: Polygon Homes TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET 11624 SE 5th St Ste 100 <br /> crry Bellevue STATE WA VP 98005 <br /> OWNER PHONE: 11E1WNER EMAIL: <br /> — v • <br /> CONTRACTOR NAME: Garner Electric WA LLC <br /> CONTRACTOR ADDRESS: sTREEr 402 Valley Ave NW Ste 106 <br /> cry Puyallup STATE WA zip 98371 <br /> CONTRACTOR PHONE:253-872-6051 'CONTRACTOR EMAIL:agentele@gweusa.com <br /> CONTRACTOR LIC.#(REQUIRED):GARNEEW864KB JCITY OF EVERETT BUSINESS LIC.#1REQUIREDI: 052909 <br /> „., <br /> PRIMARY CONTACT: DOWKIR OCONTRACTOR DOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:253-278-7064 <br /> Paul Vantol CONTACT EMAIL:gvantOl@gweusa.com <br /> AGREEMENT:i hereby certify that I have read and examined this application and know the same to 1e 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 /> fecal law regulating construction or the performance of construction. That!am authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with - State Contracto RC nd 296.200 WAC. City of Everett mow Use ooty <br /> PERMIT*: <br /> 8/3012019 E \° <br /> — <br /> eriA onzed Agigisigoatore Date (Revised 1/1112019) Pagel-Application <br />