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CITY OF TUKWILA <br />Community Development Department <br />Permit Center <br />6300 Southcenter Blvd., Suite 100 <br />Tukwila, WA 98188 <br />http: //www. ci. tukwila. wa. us <br />SITE LOCATION <br />Site Addres <br />Tenant Name: <br />Property Owners Name ,c - ' b <br />Mailing Address: <br />CONTACT PERSON Who do we contact When your permit is ready to be issued; <br />Name: <br />Mailing Address: /— ? >� di /D <br />E -Mail Address: <br />ELECTRIC 'CONTRACTORINFORMATION <br />Company Name: <br />Mailing Address: <br />Contact Person: <br />E -Mail Address: <br />Contractor Regi tration Number: /4, T Bbt <br />Valuation of Project (contractor's bid price): $ <br />Scope of Wor (pie e provide detailed inf at n): <br />Will service be altered? ❑ Yes p.,No <br />Type of Use: <br />Type of work: <br />❑ New ❑ Addition ❑ Service Change ❑ Remodel 1Tenant Improvement <br />❑ Low Voltage ❑ Generator ❑ Fire Alarm ❑ Telecommunication ❑ Temporary Service <br />Property Served by: <br />y Ll Puget Sound Energy <br />❑ Seattle City Light <br />,. Ps 5". <br />.de-TT <br />H:Upplieanons\Forms- Applications On Line \4-2007 - Electrical Permit Appliation.doc <br />bh <br />ELECTRICAL PERMIT APPLICATION <br />Applications and plans must be complete in order to be accepted for plan review. <br />Applications will not be accepted through the mail or by fax. <br />* *Please Print ** <br />• <br />King Co Assessor's Tax No.: <br />ite Number: (U (I Floor: / W <br />New Tenant: ❑ Yes $..No <br />Day Telephone y� <br />City State <br />Fax Number: <br />Zip <br />13`fs+. c 4 x4 99a.. -P <br />City State Zip <br />Day Telephone:6, ) )5tfr <br />ax Number: <br />Expiration Date: <br />Adding more than 50 amps? ❑ Yes No <br />Page 1 of 2 <br />