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0 011 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 4703 31 st Ave SE, Everett, WA I <br />BUILDING AREA (if residential, new construction, remodel, or addition) A-,"gn �.�PS) SF <br />BUILDING TYPE: ® SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />FUSE OF BUILDING: Residential use <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ has not been contracted at this time <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: All required electrical work for new Single Family - 3015B residence <br />CONTACT INFORMATION <br />OWNER NAME: Polygon WLH, LLC TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 11624 SE 5th Street, Suite 100 <br />Bellevue CITY WA STATE 98005 ZIP <br />OWNER PHONE: 425.586.7700 <br />OWNER EMAIL: <br />CONTRACTOR NAME: Garner Electric Washington, LLC <br />CONTRACTOR ADDRESS: STREET 22425 - 72nd Ave S <br />CITY Kent STATE WA ZIP 98032 <br />CONTRACTOR PHONE: 253.872.6051 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): GARNEEW864KB <br />ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: ® OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Connor King <br />CONTACT PHONE: 425.586.7700 <br />of onhomes.com <br />CONTACT EMAIL: connor.king@polygonhomes.com <br />AGREEMENT: T hereby certify that 1 have read and examined this application 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 construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Conn' -ti �bn 07/03/19 <br />Owner/Authorized Agent Sigl6ature Date <br />City of Everett Official Use Only <br />FEE <br />PERMIT # <br />EIS" �Co� <br />(Revised 1011212015) <br />