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ELECTR1CAt PERMlT APPLICATiOtV <br /> CITY flF EVERETT QERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 f FAX 425-257-8857 �(E)everetteps@everettwa.gov( www.everetfwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1 ZO�J CPaftS�11a1� Wa , DoCk H, Sli #H8 <br /> BUILD�NG AREA{if residential,n�v construction,remodel,or addition) N/A S� <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULT!-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: BOat SII <br /> ELECTRICAL APPLiCATiON INFORMATION <br /> CONTRACT PRICE OF WORK:$ 7Q0.00 <br /> NUMBER OF DEVICES if tow volta e: 1 <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if a ticabte: <br /> DESCRIPTiON OF WORK• Instaftation of a shore power ouUet to the existing power pedestat,required by the f'ort of Everett <br /> CONTACT 1NfORMATION <br /> OWNER NAME:B��� �011c�hU2 TENANT NAME If Commerciaq: <br /> OWNER MAILING ADDRESS: smEEr 5005 NE 187th Street <br /> Lake Forest Park �,� �A,�WR Lp98155 <br /> OWNER PHONE: 2d6-6O'4-3T O7 own�eR�nna�: bill.donahue@pse.com <br /> corr��e►croR NaM�:W E Electric <br /> CONTRACTORADDRESS: srneerPO BOX Z4Z7 <br /> �m,Redmond �A-�WA vP 98073 <br /> CONTRACTOR PHONE:4ZJ�-�JOH-G�SZ CONTRACTOR EMAIL: rUtl'l.W}/c1ttG WEeI@CtCIC.COfTI <br /> cot��'w►croR uc.��ReQuiReo: WEELEEE9104U CITY OF EYERETT BUSIMESS LIC.#{REQUIRE�):57075 <br /> PRIMARY C4NTACT: �OWNER 0 CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: 4ZrJ-'rJOB-�SZ <br /> Ruth Wyatt coNTacr eMn��:���,Wyatt@weelectric.com <br /> AGREEMEIVF:J hereby cerlity tha[f have read ar�d e�camined this appllcation and krrow the same fo be true and conect A//provisans of iaws and�narAces goveming this type <br /> of work wil!be compJeted wheth�ersp�ecified herEvn or not. Thegrdnti�oJa permit does nat presume togeve aufhrxity to vidate ar ca�rcel the provisions o�anyothefstate w <br /> bca!law regulating construcho»or the performance of ccxrstiuctiort 77�at 1 am aufho�izzed by the owner of riris pro�rty to perform the work for which applicaBon is made a�1 <br /> comply wifh the State Conttactors Law J8.27 RCW anci 2%2�WAC. <br /> City of Everett Of/icial Use On/y <br /> PERMIT# <br /> E �� - � <br /> OwnedAuthorized Signature Date {Revised 9/13/2016) <br />