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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 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3,a r(QJ\fO s2('Ohl vC <br /> BUILDING AREA(if residential,new construction.remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ILJ' COMMERCIAL <br /> USE OF BUILDING: 6('MT-(AL OFFlc-1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 13 5'L)()v_ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES IZ(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: i r-/.d C 4;T( / p A3 MD ANio <br /> M.D10‘r^IC-4`i-40%.1-5 0 N l s-- 14 f'( . <br /> • CONTACT INFORMATION . . • <br /> OWNER NAME: 1,11 1.../. ME.i<r QEAt 1-'4L- TENANT NAME(If Commercial): Same <br /> OWNER MAILING ADDRESS: STREET I.1b /V E. r,C(2 zra K"4° S <br /> 1V ( (1,8‘4 -- <br /> CITY Vi4c© `N✓ STATE Y I ZIP <br /> „ r <br /> OWNER PHONE: 5-D3-5;2 - 777ff OWNEREMAIL:� koze- Q.- Tr dEtyTrf-r_ _C0et* <br /> CONTRACTOR NAME: Dahl Electric, Inc. <br /> CONTRACTOR ADDRESS: STREET 3409 McDougall Ave <br /> CIT• Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: 425-252-1700 CONTRACTOR EMAIL: dstevvens@dahlelectric.com <br /> CONTRACTOR LIC.#(REQUIRED): DAHLEEI926QD CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 037024 <br /> PRIMARY CONTACT: 0 OWNER ® CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360-661-0511 <br /> Dan Stevens CONTACT EMAIL: dstevenS@dahleleCtriC.Com <br /> 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 <br /> 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 <br /> 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 t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 17— o? /Er ,f,AOLk 11(2/ . . <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />