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0 I <br /> "IIIII <br /> ELECTRICAL PERMIT APPLICATION <br /> v�_ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4510 Riverfront Blvd <br /> BUILDING AREA(if residential, new construction,remodel:or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION`INFORMATION <br /> CONTRACT PRICE OF WORK: $ 500.00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES © NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Add 15amp circuit for A/C mini split <br /> Simpson lot 216 <br /> Please call our office ( 253-872-6051 (ask for Alicia please) for payment when permit is ready Thank you <br /> CONTACT INFORMATION <br /> OWNER NAME: Polygon Homes TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: S REET 11624 SE 5th St Suite 200 <br /> c,Tv Bellevue STATE WA zp 98005 <br /> OWNER PHONE: 425-586-7700 OWNER EMAIL: <br /> CONTRACTOR NAME: Garner Electric Washington LLC <br /> CONTRACTOR ADDRESS: SIRES 402 Valley Ave NW Suite 106 <br /> c,,,, Puyallup STATE WA 21. 98371 <br /> CONTRACTOR PHONE: 253-872-6051 CONTRACTOR EMAIL: bgentelei@gweusa.Com <br /> CONTRACTOR LIC.#(REQUIRED): GARNEEW864KB CITY OF EVERETT BUSINESS LIC_#(REQUIRED): 052909 <br /> PRIMARY CONTACT: 0 OWNER (!7 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-872-6051 <br /> Paul Vantol CONTACT EMAIL: pvantol a@7gweusa.com <br /> AGREEMENT.I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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/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 <br /> City of Everett Official Use Only <br /> /f { }' PERMIT# <br /> r fJr, i 6/25/18 E I ')O l <br /> 'Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />