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rLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> (grr <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 /> PROJECT SITE,INFORMATION , <br /> PROJECT ADDRESS: 43" • '11 . , ,` - , - 11 1 1Q-il( X�f 211/61E. 1,0-t- 14 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ® SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE 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? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: All required electrical work for new Single Family- 2645A 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 GTY WA STATE 98005 ZIP <br /> OWNER PHONE: 425.586.7700 OWNER EMAIL: <br /> CONTRACTOR NAME: Garner Electric Washington, LLC <br /> CONTRACTOR ADDRESS: STREET 22425-72nd Ave S <br /> cny Kent STATE WA zip 98032 <br /> CONTRACTOR PHONE: 253.872.6051 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): GARNEEW864KB CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.586.7700 <br /> Alan Pani CONTACT EMAIL: alan.pani@polygonhomes.com <br /> AGREEMENT'T 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 <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 l 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 /> FEE <br /> CO <br /> 47 2oo <br /> PERMIT# <br /> OJaM h_ Pa mi. 01/05/18 E 1 ?;10 42-1ZIC11 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />