4619 RIVERFRONT BLVD 2020-12-23 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET.EVERETT.WA 98201 WASHINGTON (P)425 257-8810 i FAX 425-257-8857 (IEI everetteps>everettwa.gov I w�wv.everettwa.gov/permits PROJECT ADDRESS: 4619 Riverfront Blvd BUILDING AREA: sq ft PROJECT TYPE: ILI NEW CONSTRUCTION 0 ADDITION ❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR 0 TOWNHOUSE [0 DUPLEX 0 ADU rI MULTI-FAMILY-#OF UNITS, fl COMMERCIAL ..' ' adz 2 m a Y8 .8 •.�, N&P1. 4 CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: 100 amp temp power Lot 302 THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE:(SELECT ALL THAT APPLY) LINE VOLTAGE WORK? 0 NO 17 YES-Select Scope ❑Service ❑Feeder El Circuits-#; E Complete Re-wire LOW VOLTAGE WORK? (Z1 NO ❑YES-#of Devices: El SELECT SCOPE(REQUIRED). ❑Data El Intercom El Thermostat Audio 0 Secure Access ❑Security System 0 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. ©Other(List All): �xv IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: NO i YES--See Below&Pg 2 — By checking this box, I am stating that I have read and understand all of WAC 296-46B-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: [NO DYES-See Below&Pg.3 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. OWNER NAME: Polygon Homes TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: srRewr 11624 SE 5th St Ste 100 c,„ Bellevue STATE WA 7IH 98005 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Garner Electric WA LLC CONTRACTOR ADDRESS: sTREEr402 Valley Ave NW Ste 106 cr, Puyallup STATE WA err;, 98371 CONTRACTOR PHONE:253-872-6051 CONTRACTOR EMAIL:agentele@gweusa.com CONTRACTOR LIC.#(REQUIRED):GARNEEW864KB CITY OF EVERETT BUSINESS LIC.*REQUIRED): 052909 l PRIMARY CC ITACTt f;r')WNER /CONTRACTOR ElOTHER(Please Soecifvl . ....... �___.._ _.. _ CONTACT NAME: CONTACT PHONE:253 278-7064 Paul a n to 1 1 CONTACT EMAIL:pvantol@gweusa.com AGREEMENT. hereby certify that t have read and examined this application anti know the same to be true and correct All provisions of laws and ordinances governing this type of work wilt 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 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! comply with the State Contractors Law 18.27 RCW and 296.200 WAC City of Everett Official Use Only ✓ PERMIT#: .: / eye 9124t2t319 E `°ko9 Ow th rlAuorized Agent Si <£ire Date (Revised 1/11/2019) Page 1-Application