1815 13TH ST SEATTLE CHILDRENS NORTH CLINIC 2017-04-21

OLT CLECTRICAL PERMIT APPICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1815 13th St BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: E SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ® COMMERCIAL USE OF BUILDING: Lot Lighting / empwer ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: 1000.00 NUMBER OF DEVICES (if low v Itage): FIRE ALARM? ❑YES El NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: 200 amp temp power pole CONTACT INFORMATION OWNER NAME: Providence TENANT NAME(If Commercial): Aldrich & Associate OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: H&M Electric CONTRACTOR ADDRESS: STREET PO Box 799 CITY Marysville STATE WA ZIP 98270 CONTRACTOR PHONE: 360-658-0501 CONTRACTOR EMAIL: Shanrlons@hmelec.com CONTRACTOR LIC.#(REQUIRED): HMELEI*077KR CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 039193 PRIMARY CONTACT: 0 OWNER WI CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-658-0501 Troy Boggess CONTACT EMAIL: troyb@hmelec.com AGREEMENT:I 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 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# Shannary sew L4.2017 E 07 3 Owner/Authorized Agent Signature Date (Revised 9/23/2016)