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i <br /> ELECTRICAL PERMIT APPLICATION <br /> �y 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 /> PROJECT SITE INFORMATION <br /> PRo�ECT a��REss: 3020 Rucker Ave <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUP�EX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 5,900.00 <br /> NUMBER OF DEVICES(if low volta e): <br /> FIRE ALARM? ❑YES m NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> �ESCR�PTION oF woRK: Add 7 fioor outlets and 2 wall outlets to 1 st floor conference room. Re-feed roof top <br /> units from Emergency Panel <br /> CONTACT INFORMATION <br /> OWNER NAME: Snohomish Health District 7ENANT NAME(If Commercial): Same <br /> OWNER MAILING ADDRESS: sTReeT 3020 Rucker Ave #306 <br /> �,T., Everett ST,,TE WA Z,P 98201 <br /> owNER PHONE: 425-339-5200 owNER EMAi�:jneal@snohd.org <br /> CONTRACTOR NAME: Dahl EleCtflC, If1C. <br /> CONTRACTOR ADDRESS: sTReer 34�9 MCDOUgaII AV2 <br /> CITY Everett srnre WA ziP 98201 <br /> CONTRACTOR PHONE: 425-252-1700 CONTRACTOR EMAIL: CISteVGt1S Q�CIaIlI2IECtfIC.COtl1 <br /> coNT�ncTOR�ic.#�REQuiRE�>: DAHLEE1926QD CITY OF EVERETT BUSINESS LIC.#(RE4uIRED): 037024 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 36Q-66�-�51� <br /> Dan Stevens coNTacT EnnAi�: dstevens@dahlelectric.com <br /> AGREEMENT:1 hereby certify that I have read and examined fhis application and know the same to be true and correct. All provisions of laws and ordinances goveming this type <br /> of work will be completed whether specified herein or not. The g�anting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> /oca/law regulating construction or the performance of construction. Thaf I am authorized by the owner of this p�operty to perform the work for which application is made and 1 <br /> comply with the State Contracto�s Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,_ �� �e - .��2 -r� E1�1I- I � <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br />