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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
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<br /> PRo�ecT,ao�Ress: 3003 West Casino Road Everett WA 98203 Buildin 40-22
<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: $1,000
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> �escRiPTioN oF woRK: 218066 - Provide and install a camera conduit
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<br /> OWNER NAME: BO@ICl COfTI an TENANT NAME If Commercial :
<br /> OWNER MAILING ADDRESS: srReET PO Box 3707 MS 1 F 09
<br /> ��n Seattle STATE WA Z�P 98124
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: FO Grou
<br /> CONTRACTORADDRESS: sTReer g01 Powell Ave SW Suite 100
<br /> ��r Renton STATE WA Z,P 98057
<br /> CONTRACTOR PHONE: ZO6.437.63H� CONTRACTOR EMAIL: SIla1lC1011.f f0 rou .net
<br /> coNTRacTOR uc.#�ReQuiRE��: FOYGRGC863LK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O44�j69
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<br /> PRIMARY CONTACT: ❑OWNER I$�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4,25.463.rj]72
<br /> Aaron Mitchell coNTac-r ennai�: Aaron.m@foygroup.net
<br /> AGREEMENT.�T hereby certify fhat I have read and examined this application and know the same fo 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 cance/the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That!am aufhorized by the owner of this property to perform the work for which application is made and 1
<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 /> � US,E=Shannon.F@foygroup.net, (((���
<br /> �,� F 'Group,OU=Project Manager, C , Q�O� � � � �
<br /> F o v c; n p u a r�:� - annon Fuller C O
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<br /> EtECTRICAt I SOL�R I CONTROtB
<br /> Owner/Authorizeq Agent Signature Date (Revised 10/12/2015)
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