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OIL _ECTRICAL PERMIT A�-ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:4404 29th Ave SE, Everett,WA 98201 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) .....1;970-1 1121 SF <br /> BUILDING TYPE: ®SFR-DETACHED D 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? M YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: All required electrical work for new single family residence - 3015C 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 cny 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 /> cI-- 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: l 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 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 /> FEE <br /> PERMIT# <br /> Q 0.41, b_ Pa, 06/09/16 E (0()'1 - <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />