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II !LE TRI+ AL PERMIT APIILICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 # (E)everetteps@everettwa.govl www.everettwagovipermits <br /> 7 ry\ H«�......Z§... �s1 .aA., x`y, z ..,-,..' tri a,, .. 1 s3 +r <br /> PROJECT ADDRESS: 4414 31st Ave SE <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: P3 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> F <br /> .,� - .. .. .. � .. .,� �,. t.,�,. o ..\,,, w. ,.,<s�.. — A�n..,.�,;aza �r�...;� __. ._�' y„ a `.y a: <br /> CONTRACT PRICE OF WORK:$ 25C? <br /> NUMBER OF DEVICES(if lowvoltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 100 amp temp <br /> Lot 268 <br /> e, cq-0(4 - cc) <br /> Please call our office @ 253-872-6051 (ask for Alicia please) for payment when permit is ready Thank you <br /> �.t`',- * - 0 - ;� ,..6.-'fir <br /> OWNER NAME:Polygon Homes TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th St Suite 200 <br /> ori Bellevue STATE WA iia 98005 <br /> OWNER PHONE: 425-586-7700 OWNER EMAIL: <br /> CONTRACTOR NAME: Gamer Electric Washington LLC <br /> CONTRACTOR ADDRESS: STREET 402 Valley Ave NW Suite 100 <br /> city Puyallup STATE WA MP 98371 <br /> CONTRACTOR PHONE: 253-872-6051 _CONTRACTOR EMAIL: enteele eusa com <br /> CONTRACTOR LIC.#(REQUIRED): GARNEEW864KB , CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 052909 <br /> PRIMARY CONTACT: Q OWNER VI CONTRACTOR Cl OTHER(Please Specify) <br /> CONTACT NAME; CONTACTPHONE: 253-872-6051 <br /> Paul Vantol CONTACT EMAIL:pvantolkgweusacorn <br /> AGREEMENT:I hereby certify that 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 workwill 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 pedarmance 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 1&27 ROW and 296,2000 WAC, <br /> City of Everett Official Use Only <br /> . <br /> (ii,-,. /:1''' I/ '' ' 7 e/1-. ' ' '' 9/5/17 E \ - o3(c' <br /> Owner/Authorized Agent Signature Date (Revised 912312016) <br />