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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> �� > •. M.t <br /> ��� � : �; <, R , , „ ���� <br /> �� � <br /> � � :��...a:����. �..� �p. � <br /> PROJECTADDRESS: 1ZOrJ CCc1ftS171aC1 Wa , Dock H, S�I #H-29 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) N�A SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: BOat SII <br /> �`� ..�' � � � �����,�.. �.�����'���.���.`�?��� H�: � <br /> CONTRACT PRICE OF WORK:$ 700.00 <br /> NUMBER OF DEVICES if low volta e : 1 <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING 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 /> o::���' ,f"s.'.;k�c�/ r ��� �. �R" .. '��� ����b Z�� a ,3i �th��: <br /> ,� y, � � �\ q�'*� ..s \��. <br /> 3.. .... . ....<. < . ... �„ ., „ .. ..... .., ,.�,. �,.. . .... ,.., .�....� ... . �. .a..... �... <br /> OWNER NAME: BUZZ ROC�IaC1CI TENANT NAME If Commercial: <br /> OWNER MAILING ADDRESS: sTReeT510 Alverson Blvd <br /> Everett �,TM STATEWA Z,P98201 <br /> OWNER PHONE:4'Z�J-Z�0-3O3Z OWNER EMAIL: <br /> CONTRACTOR NAME:W E EI@CtCIC <br /> CONTRACTOR ADDRESS: srReeT PO BOX 24Z7 <br /> �,TM Redmond STATE WA Z,P 98073 <br /> CONTRACTOR PHUNE:4ZrJ-�JOS-63SZ CONTRACTOR EMAIL: CUtII.Wya'�C W8G'I6CtYIC.CO�'1 <br /> coNTw►cTOR uc.#�ReQuiRe�>: WEELEEE9104U CITY OF EVERETT BUSINESS LIC.#(REQUIRED):57075 <br /> �,,. . �_ ...__. ...... .. �, <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42rj-5�$-63$2 <br /> Ruth Wyatt CONTACT EMAIL:rUth.W att@weelectric.com <br /> � AGREEMENT.�I hereby certi/y that I have read and examined this application and know the same to be true and cor�ect All provisions of laws and ordinances goveming this type <br /> of work will 6e 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 tronstruction. That 1 am authorized by the owner of this properiy to perlorm the work for which application is made and I <br /> comply with the State Contractors Law i8.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> EI'1 �0- 6��3 <br /> OwnedAuthorized Agent Signature Date (Revised 923/2016) <br />