4626 31ST AVE SE 2021-12-15 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT. %1VA 98201 WAS HiNG TON1 (P) 425-257-8810 ( FAX 425-257.8857 (E) everetteps(aeverettwa.gov I www.everettwa. govipermits PROJECT ADDRESS: 4626 31 st Ave SE IBUILDING AREA: sq It PROJECT TYPE: NEW CONSTRUCTION [I ADDITION ❑ TENANT IMPROVMENT ❑ REMODEL BUILDING USE: SFR ❑ TOWNHOUSE F] DUPLEX [] ADU [A MULTI -FAMILY - # OF UNITS: ❑COMMERCIAL PRICE OF WORK: s 250 IDESCRIBE SCOPE OF WORK: 100 amp tem Lot 322 TED BUILDING PERMIT # (if applicable): THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK _ NO [I YES -Select Scope: ❑Service ®Feeder ❑Circuits #: Complete Re -wire LOW VOLTAGE WORK? 71NO ❑ YES- # of Devices: SELECT SCOPE (REQUIRED): ❑ Data ❑ Intercom ❑ Thermostat ❑ Audio ❑ Secure Access ❑ Security System 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): IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH ANDiOR PERSONAL CARE FACILITIES: (✓j NO I 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: ZN0 YES -See Below & Pg. 3 Pursuant to RCW 19.2e,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 completes! and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensingicertification requirement.. OWNER NAME: Polygon Homes TENANT BUSINESS NAME if Commercial}: OWNER MAILING ADDRESS: rREE- 11624 SE Sth St Ste 100 I ,, Bellevue STATEWA Z"' 98005 I CONTRACTOR NAME: Garner Electric WA LLG CONTRACTOR ADDRESS: s 1E�, 402 Valley Ave NW Ste 106 cn, Puyallup 13TATE WA Z,p 98371 CONTRACTOR PHONE:253-872-6051 1CONTRACTOR EMAIL: agentelea@.gweusa.com CONTRACTOR LIC, #(REQUIRED): GARNEEW864KB CITY OF EVERETT BUSINESS LIC. #(REQUIRED), 062909 r1Rlld1ARY rONTACT I�4WNER FV 01NITRACTOR FlOTHER (Please Specify) ... CONTACT NAME: Paul CONTACT PHONE: 253-278-7064 �� CONTACT EMAIL: pvantol@gweusa.com same type of aaom avert Ike comptereo whether specittedheretn or not, 7 he granting of a permit does not presume to give authority to violate or cancel the promvns of any other stag or kxal law regulating construction or the peftmance Of construction That i am authorized by the owner of this property to perform the work W which application is made and i comply with the State Contractors taw 18,27 RCW and 296 200 WAG. City of Everett Official Use Only EE� �o°i �� `9724r2t719 s Owned thorized A t Ignf,(mre Date fRevised 1/11120191 Page 1-Application