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�ECTRICAL PERMIT AP�ICATION
<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� .ev a.gov/permits
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<br /> PROJECT ADDRESS: 3003 W2St CaS1110 ROaCI, Everett, WA 98203 Buildin 40-26 P-R/7-9
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY- F UNITS: I$I COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WO : $2,000
<br /> NUMBER OF DEVICES if low olta e :
<br /> FIRE ALARM? ❑YES ❑ O
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> �ESCRiPT�oN oF woRK: 17-0526 40-26 Kiosks Mobile Cart
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<br /> OWNER NAME: BO@ICI COt11 a11 TENANT NAME If Commercial):
<br /> OWNER MAILING ADDRESS: sTReeT 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 /> CONTRACTOR ADDRESS: srReer
<br /> ��n Seattle STATE WA Z�P 98117
<br /> CONTRACTOR PHONE: ZOG.437.635') CONTRACTOR EMAIL: SI181111011.f f0 rou .net
<br /> coN-rRacTOR�ic.#�REQu�REo>: FOYGRGC863LK CITY OF EVERETT BUSINESS LIC.#(REQUIRE : O44rj69
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<br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: t�2rj.463.�j772
<br /> Aaron Mitchell coNTacT EMai�: Aaron.m@foygroup.net
<br /> AGREEMENT.�T hereby certify that 1 have read and examined this application and know the same to be true and correct. AI!provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or nok 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 I am authorized by the owner of this property to perform the work for which application is made and 1
<br /> compty with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
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<br /> �i signed by Shannon Fuller PERMIT#
<br /> US E-Shannon.F@foygroup.net,
<br /> F Group,OU=Project Manager, / /
<br /> F u v €; rf s� � €� �"�annon Fuller L �� ,.._ l 1 _ ! �-,
<br /> EIECTRICAt � SOLFR � CUNiflots�-<- "'-2016.02.22 08:59:11-08'00' �_� �S✓
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<br /> Owner/Authorizetl Agent Signature Date (Revised 10/12/2015)
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