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EY <br />(P) 425-257-8810 <br />ELECTRICAL PERMIT APPLICATION -- <br />CITY CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 9 P "1* _77— ___124 <br />BUILDING. AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: Z5P,4 r <br />LECTRICA APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: <br />I lea' <br />NUMBER OF DEVICES (if low v <br />to e): <br />FIRE ALARM? ❑ YES I <br />❑ NO <br />ASSOCIATED BUILDING PERM <br /># if appf ble): <br />DESCRIPTION OF WORK: C b ► cu f ve_ %'I +£ r&t <br />ELCLrt-tGa4w wfi-r <br />sYSTA <br />CONTACT INFORMATION <br />/ <br />OWNER NAME: T 6 ILL I► OK TENANT NAME (If Commercial): Same <br />OWNER MAILING ADDRESS: STREET s 'r 4 % W <br />CITY vtso_c, 77_ STATE 14 A ZIP <br />OWNER PHONE: S' 4''S �i - l)� OWNER EMAIL: k,/ kI COv►n <br />CONTRACTOR NAME: Dahl Electric, Inc. <br />CONTRACTOR ADDRESS: STREET 3409 McDougall Ave <br />CITY Everett STATE WA <br />CONTRACTOR PHONE: 425-252-1700 <br />CONTRACTOR EMAIL: dsteveris@dahlelectric.com <br />CONTRACTOR LIC. #(REQUIRED): DAHLEE1926QD <br />ICITY OF EVERETT BUSINESS LIC. #(RE IRED): 037024 <br />PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Dail Stevens <br />CONTACT PHONE: 360-661-0511 <br />CONTACT EMAIL: dstevenS@dahlelectric.com <br />AGREEMENT: l 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/ am authorized by the owner of this property to perform the work for which application is made and/ <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />Agent Signature Date (Revised 9123120.16) <br />