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ELECTRICAL PERMIT APPLICATION <br /> I'►' �.. 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 I www.everettwa.gov/permits <br /> .....:.. <br /> ....:.:;:: <br /> P . O .ECT S .. TC ... ......... :..... <br /> , . .. .._.... .... ..... .IIT .1 TE IK OI# ON.... ............................. <br /> PROJECT ADDRESS: 4501 30th Dr SE <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 /> CONTRACT PRICE OF WORK:$ 250 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 100 amp temp pole Lot 244 <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: STREET 11624 SE 5th St Suite 200 <br /> circ Bellevue STATE WA ZIP 98005 <br /> OWNER PHONE: 425-586-7700 OWNER EMAIL: <br /> ..... .. . .... ..... .... .. <br /> CONTRACTOR NAME: Garner Electric Washington LLC <br /> CONTRACTOR ADDRESS: STREET 402 Valley Ave NW Suite 106 <br /> c„',. Puyallup STATE WA zip 98371 <br /> CONTRACTOR PHONE: 253-872-6051 CONTRACTOR EMAIL: bgentele@gWeUSa.Com <br /> CONTRACTOR LIC.#(REQUIRED): GARNEEW864KB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 052909 <br /> PRIMARY CONTACT: El OWNER ca CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-872-6051 <br /> Paul Vantol CONTACT EMAIL: pvantol©gweusa.com <br /> AGREEMENT:1 hereby certify that I have reed 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 I 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 /> )11/ <br /> i , PERMIT# <br /> 2//7 E P-Vo el 3 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />