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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 /> , , ,:.,, <br /> ..�- - ����cC `�,,`-�`��.���_,-.:: .�°'� ��, ... � \ ` � �\�,. �\\���'� �� \: <br /> �����. �". c"����,�.:. \. � �v.....z: <br /> PRo�ec-raooRess: 3003 West Casino Road Everett WA 98203 Buildin 40-22 Column 9F <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: C�COMMERCIAL <br /> USE OF BUILDING: <br /> \ ���;�, � Y�` ,� <br /> �• ,� <br /> CONTRACT PRICE OF WORK: $3,000 <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF WORK: 17-0516 40-22 install ice well <br /> � ��,v.. <br /> xF� i,.:�-6 SZ,� � '� r��-` "�'a �� a� �r:: �,. �r � � t <br /> ,r.. �+� ' t <br /> OWNER NAME: B021t1 COtYt an TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer PO Box 3707 MS 1 F 09 <br /> o�n Seattle STATE WA Z�P 98124 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: FO Grou <br /> CONTRACTOR ADDRESS: sTReer <br /> ��TM Seattle STATE WA Z�P 98117 <br /> CONTRACTOR PHONE: ZO6.437.63H� CONTRACTOR EMAIL: SIlaI1C10C1.f f0 rou .net <br /> coNTwe,cTOR uc.#�REQu�RE��: FOYGRGC863LK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Ot�4rj69 <br /> � , �M .�. �. .. ... , <br /> PRIMARY CONTACT: ❑OWNER (SI CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42rj.[�63.�j]72 <br /> Aaron Mitchell coNTACT eMai�: Aaron.m@foygroup.net <br /> AGREEMENT.�T hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and orciinances goveming this <br /> type of work will be completed whether spec�ed herein or not. The granting of a permit does not presume to give authority to vio/ate or cancel the provisions of any other state or <br /> local law regu/ating construction or the performance of construction. Thaf 1 am authorized by the owner of this property to pertorm 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 <br /> FEE <br /> ��2 - S � <br /> signed by Shannon Fuller PERMIT# <br /> � US,E=Shannon.F@foygroup.net, <br /> F Group,OU=Project Manager, I <br /> F o r � x a � a = annon Fuller E l�� /' \� <br /> ELECTRICAL � SOLAR I CONTRULS <br /> Owner/Authorizetl Agent Signature Date (Revised 10/12/2015) <br />