|
NMI
<br /> az ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET.EVERETT.WA 98201
<br /> WASHINGTON (P)425-257-8810 [ FAX 425-257-8857 I(Ei everetteps@everettwa.gov 1 www evereftwa gov/permits
<br /> •PROJECT SITEINFO7, ;;ATP
<br /> PROJECT ADDRESS: 4620 31St Ave SE BUILDING AREA: sq ft
<br /> PROJECT TYPE: 0 NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT El REMODEL
<br /> BUILDING USE: El SFR El TOWNHOUSE 71 DUPLEX El ADU El MULTI-FAMILY-#OF UNITS. 0 COMMERCIAL
<br /> 12z .‘i",':NAMV..,.;:...;',‘;' -.:•-• ICAVIS„,,:e„,:L,6,*,i1'* ».,' ..1A1.41:14,1;,-LI,a,i :..:'':.AM-,',-.,,,;;IPTION4W-',i,,j7f,%2WPS:41, 4::aal
<br /> CONTRACT PRICE OF WORK:$ 200 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 100 amp temp power
<br /> lot 324
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? 0 NO El YES-Select Scope:El Service El Feeder 0 Circuits-#: El Complete Re-wire
<br /> LOW VOLTAGE WORK? El NO El YES-#of Devices:
<br /> SELECT SCOPE(REQUIRED); El Data El Intercom ID Thermostat lE)Audio 0 Secure Access El Security System
<br /> Li 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 /> n Other(List Ally
<br /> ;.,..,.,..i..; I -.,,:C.;,,,s,--A--:.C,.4,-.:.,
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 6.../ NO LI YES-See Below&Pg 2
<br /> [1 By checking this box,I am stating that I have read and understand all of WAC 296-48B-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: ENO DYES-See Below&Pg.3
<br /> r— Pursuant to ROW 19.28.261,property owners and leasehotders cannot perform electrical work on buildings for rent,sale or lease
<br /> 1 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 Icensing/certification requirement.
<br /> 0
<br /> OWNER NAME: Polygon Homes TENANT BUSINESS NAME Of Commercial):
<br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th S Ste 100
<br /> c,,, Bellevue STATE WA zip 98005
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Garner Electric WA LLC
<br /> CONTRACTOR ADDRESS: stassr402 Valley Ave NW Ste 106
<br /> ciry Puyallup STATE WA z,,„ 98371
<br /> CONTRACTOR PHONE:253-872-6051 CONTRACTOR EMAIL:agentele@gweusa.com
<br /> CONTRACTOR LIC.fiiiREOUIRED):GARNEEW864KB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 052909
<br /> PRIMARY CONTACT: [DOWNER [Z1CONTRACTOR OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:253-278-7064
<br /> Paul Vantoli
<br /> CONTACT EMAIL:pvantol@gweusa.com
<br /> 'AG/4E041E1%1T I hereby certify that I have read and examined thls apolicatkan 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 constmotion That I am authorized by the owner of this property to perform the work for which application is made and/
<br /> comply with the State Contractors Law 18 27 RCW and 296.200 WAC. City of Everett Official Use Only
<br /> P ZEERMIT#R: 0 — 0 S S
<br /> i
<br /> 41 gial- 0 ?//in
<br /> —owner/Authorized Agent i attire te 7 ' (Revised 1111/2019) Page 1-Application
<br />
|