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OMNI • •
<br /> an ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa gov I wiiiiviteverettwa gov/permits
<br /> inAsHinoroN
<br /> s ' '' -• '" ', ,f-Ai'','PROJECT SITE INFORMATION
<br /> ,...,..... ,
<br /> PROJECT ADDRESS: 4624 Riverfront Blvd BUILDING AREA: sq ft
<br /> PROJECT TYPE; [Z] NEW CONSTRUCTION 0 ADDITION LI TENANT IMPROVMENT 0 REMODEL
<br /> BUILDING USE: EI SFR E TOWNHOUSE D DUPLEX 0 ADU LI MULTI-FAMILY-#OF UNITS: El COMMERCIAL
<br /> ',„,;,,; ''''''''.:,-,:i,'''':''' • ELECTRICAL APPLICATION INFORMATION S,DESCRIPTION OF WORK
<br /> CONTRACT PRICE OF WORK:$ 250 ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIBE SCOPE OF WORK:
<br /> 100 amp temp power
<br /> lot 370
<br /> THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY)
<br /> LINE VOLTAGE WORK? El NO 0 YES-Select Scope. 0 Service El Feeder 0 Circuits-#: 0 Complete Re-wire
<br /> LOW VOLTAGE WORK? I NO 0 YES-#of Devices:
<br /> 0 '
<br /> SELECT SCOPE(REQUIRED), LI Data 0 Intercom 0 Thermostat El Audio E3 Secure Access 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 /> El Other(List All):
<br /> CODE COMPLIANCE
<br /> IS THIS PERMIT EDUCATION,INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: 0 NO 0 YES--See Below&Pg.2
<br /> 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
<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: .,Tr NO 0YES-See Below&Pg. 3
<br /> i I Pursuant to RCW 1928.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease
<br /> I I 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 licensingicertificationrequirement.
<br /> ',,•, :'<ft,' s ::fi, ,.,,.-i • 2--.'i.:%,,,i-iw",i0'0. 1:5''',,••i,''''-iffl',00-141ACT INFORMATION'''' '!.': '',•''''''.::4','''''''' ' .•,:q,",.:,4,,,,,,,,-T ''2-.''''.' i';,
<br /> OWNER NAME: Polygon Homes TENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th St Ste 100
<br /> CITY Bellevue STATE WA ZIP 98005
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Garner Electric WA LLC
<br /> CONTRACTOR ADDRESS: siFir.-ET 402 Valley Ave NW Ste 106
<br /> crry Puyallup STATE WA ZIP 98371
<br /> CONTRACTOR PHONE:253-872-6051 CONTRACTOR EMAIL:agentele@gweusa.com
<br /> CONTRACTOR LIC.#(REOUIRED):GARNEEW864KB CITY OF EVERETT BUSINESS LIC.#(REOUIRED): 052909
<br /> PAINIARV CONTACT': ElotAnNicR ITACONTRACTOR FlOTHER(Please Specify) _
<br /> CONTACT NAME: CONTACT PHONE:253-278-7064
<br /> Paul Vantol CONTACT EMAIL:pvantol@gweuSa.com
<br /> t
<br /> AGREEMENT I hereby certify that I have read and examined this application and know the same to be true and correct, Ali 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 I am authorized by the owner of this property to perform the work for which application is made arid!
<br /> comply with the State Contractors(Lape 18 27 ROW and 298,200 WAC. City of Everett Official Use Only
<br /> ,, PERMIT lit,;.. ,
<br /> z (4164:711—, -011: J 12/26/2019 E viV2,-- I Col
<br /> dwnenAuthorized Agent Sig Lure Date (Revised 1/11/2019) Page 1-
<br /> Application
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