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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE 1NFORMATiON <br /> PROJECTADDRESS: 12O�J CraftS111aC1 Wa , DOCk H, Sfi #H22 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) N/A SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACNED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: BOat SII <br /> ELECTRtCAL APPLfCAT10N iNFORMATION <br /> CONTRACT PRICE OF WORK:$ 700.00 <br /> NUMBER OF DEVICES if low volta e : 1 <br /> FIRE ALARM? ❑YES a NO <br /> ASSOCIATED BUI�DING PERMIT# if a licable: <br /> DESCRIPTION OF WORK• Installation of a shore power outlet to the existing power pedestal,required by the Port of Everett <br /> CONTACT:fN�ORMATION <br /> OWNER NAME:Datl BaCtI@tt TENANT NAME(If CommerCial): <br /> OWNER MAILING ADDRESS: srneEr I�QD� I V '� � 1 v � <br /> CIN M�V I���Q STATE,Y� ` LP ` �'�� <br /> OWNER PHONE: 360-659-75 OWNER EMAIL: thehOIICIB�/C/fl'Otltl@f.001'Yl <br /> corrrRacroR Nanne:W E Electric <br /> CONTRACTORADDRESS: snxeErPO BOX 24Z7 <br /> ��,Redmond STA,�WA rP 98073 <br /> CONTRACTOR PHONE:4Z�J-�JOS-G3HZ CONTRACTOR EMAIL: CUtII.W�/attC�W@@IBCtt'IC.COtII <br /> conrrw►cTOR uc.��ReQu�Reo�_ WEELEEE9104U CITY OF EVERETT BUSINESS LIC.�(REQUIRED):57075 <br /> PRIMARY COPRACT: ❑OWNER 0 CONTRACTOR ❑OTHER{Please Specify} <br /> CONTACT NAME: CONTACT PHONE: 4.2rj-rj0$-6$$2 <br /> RUtfl W�/att CONTACT EMAIL:rUtF}.W�l3ttC W@@IeCtfIC.00111 <br /> AGREEMENT.•l hereby certify that l have read a�+d examined tfris app(ication and know the same to be Prue and correct All provisions of/aws and ordinances goveming this type <br /> of work wil/be co�vleted whetherspecified herein ornoZ The gran6ng ofa p�emvtdoes not presume to give authority 1c�viWate or czr�ce/the provisions ofanyotherstate or <br /> local law regula6ng consduction or ihe perlormance of construction. That I am authorized by the owner of this properly to perform the work for which appl'icafion is made and I <br /> comply with the Stata Contractors Law 18.27 RCW and 296.200 WAG <br /> City of Everett Officia!Use On/y <br /> PERMIT# <br /> E i�o� -� �� <br /> OwnedA rize Agent ure Date (Revised 9/23/2015) <br />