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�L�c���c�L �����-r �����c���o� <br /> �y CI I Y OF E�iERETT PCRi��il I SER`✓ICES <br /> 3200 CEDA.R STREET, EVERETT, VVA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (Ej everetieps@everet��a.gov � ��v1nnN.ev2reit��va.gov/permits <br /> P�ZOJECT SIT� IPdFORMAT10P1 <br /> � <br /> PROJECT ADDRESS: � � � '� �I/r � ��'yLb-l4L(. <br /> BUILDING AREA(Ir resfdenli2l, ne�v cons[ruction. remodel. or acdi[ionj_ _ _ SF <br /> BUILDING TYPE ❑ SFR-DETACHED ❑ SFR-F,TTACHED ❑ UUPLFX ❑ NiUL I I-FAi�illLY #OF UNI'15: ❑ CONIMERCIAL <br /> USE OF BUILDMG �-�(��'�C:._. �_�l.t�'1,:1(_ <br /> LECTRICAL APPLiCAT10N IP+1FORiVtAT1�N <br /> CONTRACT PRICE OF WORK: � � /�(��'� <br /> NUMBER OF DEVICES (if Io�N voltag : <br /> FIRE ALARM? ❑YES <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: • � y!� C,1�C� i 7—" /"c%°� �a?LL_ ��'`, r-��'.:� <br /> G��ITACT INFOFZlVIATl0�+1 <br /> OWNER NAME: f/�,�/�='T �j��. /�L `/ TENANT NAME(if Commercial): S�me <br /> OWNER MAILING ADDRESS: srREEr 31� j /��' i��:4L-i/{L�. <br /> arr �� V�vs2,�; � sraTe �� zia � ��� � <br /> .-. — <br /> i•- • <br /> c>��,rir �. Ffir�r�� �j,2 7 � � 5 `t- �l_t 3� ��vv��� F��nni� ee-�� -_�_�r�-i �=��- �_ �l�ri ��3 2��jy cc�,f,� <br /> cor�rRacro� rv�v�E: D��hl E-lectric. Inc. <br /> coNrRacTOR a��REss: ��;,�=1 3409 McDougall Ave <br /> �,;., Everett s;..,�E WA �,P 98201__ <br /> CONTRACTOR PHONE: �25-�52-170� coNTRacroR E�na«: dstevens@dahlelectric.com ;, � <br /> coNr��croR uc.�;r�Eou�F��o�: �f>�LEE1�26C�D� ciTv oF EVER�rT BusiNEss uc.��Fou��E��: ��i02���' <br /> PRIMARY CONTACT: ❑ O�P/NER � CONTRf�CTOR ❑OTHER(Please Specif�j) __ <br /> CONTACT NA�/IE: CONTACT PHONE: 360-66�-Q511 <br /> Dan Stevens covTacT EMai�: dstevens@dahlelectric.com <br /> AGR_FF��fENT:I hereby cerh��rhaf 1 nava�e�d and ex2mmEd fh�s application and kno�.v fha sam,e to be f�ue ar,d corracl_ All provrsicns of lav+s a�d cidinancas gov�ming;h,is tyFa <br /> o;svo�1����ill be complated whelhei speahed herein er nof. Tha q��nhng or�pe�m�t do2s not p�esume lo give aufhor;ty lo v�olafe o�cancel th,e prov+sions of an�o,her;i2te o� <br /> �ocsl la�.v�egulating construchon or the pe�;o�mance oi consf�ur_oon Thaf I am aurhonzed b�the ovme�07 this prope�ty fo pe�loim the wo�k for which ar�plication rs made ano I <br /> canply�.vrth the Staie Conf�ac(ors La�v ]Ci 27 r2CLV an�29b-�00'vV„C. <br /> '.�lq Oi�veie!t l;�if��.i.�-1 IJ�„ r:nl�, <br /> h'�'F:Pvilr f <br /> r .z - � I�1 � 2� I 2� <br /> �� _ � � �-A"7_ _ _.._.�...�..___..._ <br /> OwneriAu[horizeci kgent Signature l�,s�tr (RevrseJ�,-'23i2016,i <br />