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'RECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www-everettwa,gov/pefinits <br />PROJECT ADDRESS. 2920 47th St SE IBUILDING AREA: sq ft <br />PROJECT TYPE: Z NEW CONSTRUCTION El ADDITION El TENANT IMPROVMENT [I REMODEL <br />BUILDING USE: Z SFR [I TOWNHOUSE [I DUPLEX 0 ADLI EIMULTI-FAMILY -#OFUNITS: _ MCOMMERCIAL <br />- !IN <br />7, J ­4 'DESCRIPTION OVWORK <br />IILRCTRICAL AP CIT 10" INFORMATION <br />ICONTRACT PRICE OF WORK: s 250 JASSOCIATED BUILDING PERMIT # (if applicable): <br />IDESCRIBE SCOPE OF WORK: <br />100 amp temp power <br />Lot 361 <br />THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) <br />LINE VOLTAGE WORK? W1 NO E YES - Select Scope: El service E Feeder 7 Circuits-* ElComplete Re -wire <br />LOW VOLTAGE WORK? 521 NO D YES- # of Devices: <br />SELECT SCOPE (REQUIRED): [] Data 0 Intercom ❑ Thermostat 7 Audio F-1 Secure Access ❑ Security System <br />F-1 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 />D Other (List All): <br />IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: [Z] NO YES See Below & Pg. 2 <br />F� 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: 7VINO DYES -See Below & Pg. 3 <br />Pursuant to RCW 19.26.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease <br />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 licensing/certification requirement, <br />OWNER NAME: Polygon Homes TENANT BUSINESS NAME (if Commercial): <br />OWNER MAILING ADDRESS: IT111T 11624 SE 5th St Ste 100 <br />G,TY Bellevue STATE WA Z,,98005 <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: Garner Electric WA LLC <br />CONTRACTOR ADDRESS: sTRr T402 Valley Ave NW Ste 106 <br />CITY Puyallup $TATEWA ztp 98371 <br />,CONTRACTOR PHONE: 253-872-6051 1CONTRACTOR EMAIL: pvantol@gweusa,corn <br />1CONTRACTOR LIC. #(REQUIRED): GARNEEW864KB ICITY OF EVERETT BUSINESS LIC. #(REQUIRED): 052909 <br />PRIMARY CONTACT- [ . ..... IOWNPR F,/_jI!-0NTPA(-TnP MIC.) T " P P (PlonF. Sp*ify) <br />CONTACT NAME: CONTACT PHONE: 253-278-7064 <br />Paul Vantol <br />1 ICONTACT EMAIL: pvantol@gweusa.com <br />AGREEMENT i hereby certify thathave read and examined this application and know the same to be true and correct. All provisions of laws and Ordinances governing this <br />IYPU or WUFK win oe compiezea wnernerspectrieci nerein or not. the granting of a permit does not Presume to give authority to violate of cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. That /am authorized by the owner of this property to perform the work for which application is made and I <br />Comply with the State Contractors Law 18.27 RCW and 296,200 WAC. City of Everett Official Use only <br />T # <br />"4 <br />'41 EE� <br />1114/2020 zxl�, Cgo <br />Owner/Authorized Agent Sign-7-.11. Date (Revised 1/1112019)' Page 1-Application <br />