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12/09/2016 09 : 52 #1412 P. 001/001 4rerr ..ECTRICAL PERMIT AMt'LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa_gov I Www-everettwa_gov/permits PROJECT SITE INFORMATION, . PROJECT ADDRESS: {Liu C T u I W"( _ BUILDING AREA(if residential,new construction, remodel,or addition) sF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX R MULTI-FAMILY-#OF UNITS: CI COMMERCIAL USE OF BUILDING: FAAAf 14 1 '5, CC • • ELECTRICAL. APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ // 0Oc., — N UMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: n (VA._fp , t i VA-vii i) 4fterh coce.. I -R lntr d 1 i— 4' 4l(Ff> 4 ufl t A DJ_q.it1 Li__ I.f4 e CONTACT INFORMATION, • OWNER NAME: Li 5 p,q- PPP Ck r l' TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTRFET j) a %a X' 3?-5!, . CITY 1 M(f STATE [A /,+ ZIP 9f,C 9��/ OWNER PHONE: 0 (p ,2), (# p (,� OWNER EMAIL: CONTRACTOR NAME: E i..(OtYt.+l, .0.-Les- f 1'e kw1[f CONTRACTOR ADDRESS: STREET 31P IQ'/1 EC'c`iu 1 ,f _ t- I� //� CITY '/ v t q � STATE (/ 9!' ZIP 7 2O/ CONTRACTOR PHONE:LIZ S !�. pZ I Ct ( CONTRACTOR EMAIL: ((//`� /.�1 ......./. V . CITY OF EVERETT l3USINESS LIC.#(REQUIRED):/p g CQNTRAGTOR LIG.#(REgUIRED): �`�1 PRIMARY CONTACT: El OWNER 0 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: y l 0 -Z 07 (&WEL( O,S CONTACT EMAIL: AGREEMENT. T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances Governing this 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 local law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application Is made and 1 comply with the State Contractors Law 18.27 ROW and 296,200 WAC, City of t verett official Use Only 2 FEE s°0 r 411 9:)_.-- i ' _.----------- -- PERMIT# 1Z\ b�I�1� E (9`)._ 'D510 Owner/• t •riz.d •gent Signature Date (Revised 10/12/2015)