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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.everetfinra.gov/permits
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<br /> PRo�ecTa�oRess: 3003 West Casino Road Everett WA 98203 Buildin 40-22 Facto Shift Bell
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �I COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK: $6,000
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> DESCRIPTION OF WORK: 217442 - Provide ower to new facto shift bells
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<br /> OWNER NAME: BO@IC1 COfYI an TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: s-rReeT PO Box 3707 MS 1 F 09
<br /> ��N Seattle STATE WA Z�P 98124
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: FO Grou
<br /> CONTRACTORADDRESS: sTReeT 901 Powell Ave SW Suite 100
<br /> ��n Renton STATE WA Z�P 98057
<br /> CONTRACTOR PHONE: ZO6.43T.63H'I CONTRACTOR EMAIL: SI1811t1Otl.f f0 rou .net
<br /> coNTwacTOR uc.#�REQuiREo�: FOYGRGC863LK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Ot�4rj69
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<br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4.25.463.rj7]2
<br /> Aaron Mitchell coN-racr eM,ai�: Aaron.m@foygroup.net
<br /> AGREEMENT.�T hereby certify that I have read and examined this application and know fhe same to be true and correct. AU 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 pertormance of construction. That 1 am authorized by the owner of tAis properly to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
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<br /> �', signed by Shannon Fuller PERMIT#
<br /> �' ,a,�J*1 �"US,E=Shannon.F@foygroup.net,
<br /> �,; � F Group,OU=Project Manager, C �� ( _ � � �
<br /> F o v r; n � � �� �N annon Fuller C
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<br /> EIECTRICAI � SOI�R I CUNTROtB�~c�i.�.��.�......,... �
<br /> Owner/Authorizetl Agent Signature Date (Revised 10/12/2015)
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