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NAME: __________________________________________________________________ PHONE:  __________________________ <br />STATE OF WASHINGTON CONTACTOR’S LICENSE:  _____________________________________ UBI#: ______________________ <br />CITY OF RENTON BUSINESS LICENSE:  ___________________________________________________________________________  <br />H:\CED\Data\Forms-Templates\Self-Help Handouts\Building\2019 Forms-Fillable\Electrical.pdf                               Updated 1/8/2020 <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />Development Services Division <br />1055 S. Grady Way <br />Renton, WA 98057 <br />(425) 430-7200 <br />www.rentonwa.gov <br />ELECTRICAL PERMIT <br />APPLICATION <br />FOR OFFICE USE ONLY: <br />PERMIT NUMBER:  _______________________ PROJECT NUMBER:  ___________________ LAND USE NUMBER:  ______________ <br />ASSOCIATED BUILDING PERMIT NUMBER (REQUIRED): ____________________________________________________________ <br />This number is required if your work is associated with work being done under a Building Permit.  The Building Permit could belong  <br />to someone else, but we still need the number to keep all associated permits tied together. You may need to contact the Building  <br />Permit owner.  <br />1. LOCATION AND VALUATION INFORMATION <br />JOB ADDRESS:  _____________________________________________ TENANT NAME:  ___________________ LOT #:  _________  <br />VALUE OF WORK: (Fair market value for time + materials) $___________________ BOEING JOB # (If applicable):  ______________  <br />DESCRIPTION OF WORK:  ______________________________________________________________________________________ <br />2. OWNER INFORMATION <br />PROPERTY OWNER NAME:  ____________________________________________________ PHONE:  __________________________________ <br />ADDRESS:  ________________________________________________________ CITY:  ______________ STATE:  ________ ZIP:  _______________ <br />3. CONTACT INFORMATION <br />CONTACT NAME:  _____________________________________________________ PHONE:  ______________________________  <br />EMAIL:  ______________________________________________________________ FAX:  _________________________________ <br />4. CONTRACTOR INFORMATION <br />DOING WORK AS OWNER/CONTRACTOR?     If yes, the owner will need to fill out the Electrical Owner Affidavit Form.   <br />Include this form with your submittal.  Tenants cannot do the work without written permission from the owner.  <br />A LICENSED CONTRACTOR WILL BE DOING THE WORK.   Fill out the portion below. (Required):  <br />This application must be filled out completely in order to be submitted for review. We will not accept incomplete applications. This <br />application is good for one (1) year from the submittal date. A one-time extension of one (1) year can be requested at a cost of half <br />the plan review fee. Once issued, the permit is good for one (1) year from issue date. A one-time extension of one (1) year can be <br />requested at a cost of half the permit fee. Please follow our Electronic File Standards if your permit requires plan review. This <br />application must be a .pdf and included in your submittal.