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MECTRICAL PERMIT AP ICATION
<br /> gn. CITY OF EVERETT PERMIT SERVICES
<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 /> �� �; ' 'Y 'r ;5 tPROJECT,SITE INFORMATION 't
<br /> PROJECT ADDRESS: 33/O 0/ _5 Acis% S�
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) • SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED El-DUPLEX 0 MULTI-FAMILY-#OF UNITS: .COMMERCIAL
<br /> USE OF BUILDING: �jC &c,,/(cIr /�v� ;L�fl/ri �i�/�!G/= //--4-/ �/,c
<br /> <;'}� ti i Yea X 3 � �,'..r �L� 7��s� k i�"'Y S^s. t',y..;,; @,�v.� s�t+•�:�xY:•rq t �;Mrcnx� np ar'«i��, m:.c ti�tti s�un...,,:,i�� >u x y4,n w*.f sx-a `t� �rx� a,:_��z) � jF1'k��1�° + K '
<br /> a ELECTRICAL APPLICAT gfJ3E FORMATION > t °'
<br /> ...'��v �*-��...s�?','�,.>c,t}i..}}.;.���t.,�,.°..;.?.d.t:a .�cA.:�r� _A..._.,. ,.��u�..�naN t„�sc��.,�,....aeaf„�..d.x..,�cw ..Mrd„�,t,<.o��.,��.t•,.e....�n�.;:�.�1"..x.!r,�«t,<.it,.,t>ey.,x.�,.e�n,x ...��;�,x..�;.,w,u ,.,......5=..-.,..,.i ..,fY.Y,:��,..xw,.
<br /> CONTRACT PRICE OF WORK: $ C9UG —
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES ..B'NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): /t/V
<br /> DESCRIPTION OF WORK: /1/#5 Goo /7P !(//c F.
<br /> CONTACT INFORMATION
<br /> OWNER NAME: A/644/44 idd ' 1f7' TENANT NAME(If Commercial): �, C,t/A/ ,3_4zL
<br /> OWNER MAILING ADDRESS: STREET 33 cpe, e a A2 r3 f
<br /> t've rr CITY W)/7 STATE ZIP 7V.Z.0
<br /> OWNER PHONE: .41,Z S S% 7/7/ OWNER EMAIL:
<br /> CONTRACTOR NAME: United Electric Contractors, Inc,
<br /> CONTRACTOR ADDRESS: STREET 5301 South 2nd Avenue
<br /> CITY Everett STATE WA zip 98203.4112
<br /> CONTRACTOR PHONE: 425-252-7811 CONTRACTOR EMAIL: unitedelectric@Comcast.net
<br /> CONTRACTOR LIC.#(REQUIRED): UNiTEEC 176 M6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019434
<br /> PRIMARY CONTACT: 0 OWNER ICI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: Dave Hammer, Principal CONTACT PHONE: 425-252-7811
<br /> CONTACT EMAIL: unitedelectric@Comcast.net
<br /> AGREEMENT. T hereby certify that 1 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 t
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> i
<br /> PERMIT#
<br /> •
<br /> Eigo[ -- O
<br /> Owner/Authoriz -•nt Signature D (Revised 10/12/2015)
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