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1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER.ETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 ( (E)everettepsi everett ia.gov J www.everettwaigovipermits <br /> PROJECT ADDRESS: 4512 29th Ave SE <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX CI MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> . y ELES T' Ppu ATI . � . ' , MAIION <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 WORK100amp temp <br /> Please call our office c 253-872-6051 (ask for Alicia please)for payment when permit Is ready Thank you <br /> OWNER NAME:Polygon Homes TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 11624 SE 5th St Suite 200 <br /> ury Bellevue sriirt WA zip 98005 <br /> OWNER PHONE: 425-586-7700 [OWNER EMAIL: <br /> CONTRACTOR NAME: Gamer Electric Washington LLC <br /> CONTRACTOR ADDRESSSTREET402 Valley Ave NW Suite 106 <br /> cirY Puyallup si rs WA zip 98371 <br /> CONTRACTOR PHONE: 253-872-6051 CONTRACTOR EMAIL: Dgentele CIgweusa.com <br /> CONTRACTOR LIC.#(REQUIRED): GARNEEW864KB CITY OF EVERETT BUSINESS LIC.#(REOUIRED): 052909 <br /> PRIMARY CONTACT: 0 OWNER to CONTRACTOR 0.OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-872-6051 <br /> Paul Vanto! CONTACT EMAIL: <br /> I pwantol a9welasa.ccsrr► <br /> AGREEMENT:I hereby certify that t have read and examined this application and know the same to be We and correct XVI provisions of laws and ordinances governing this type' <br /> of work will he completed whether specified herein or not. The tenting of a permit does not presume to give authority to violate or cancel the provisions ofany other state or <br /> local law regulating construction or the perfotrnance of construction. That i am authorized by the owner of this property to perform the work for which application is made and d <br /> comply with the State Contractors Law 18.27 RGW and 296,200 WAS <br /> City of Everett Official Use Only <br /> PERMIT <br /> 7/19/18 E O�," \,D\ <br /> OwneriAutharired Age Signature Date (Revised 9/2312016) <br />