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— ELECTRICAL PERMIT APPLICATION <br /> eill'� <br /> 01 - CITY OF EVERETT PERMIT SERVICES <br /> EV <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: i s'"30 I:. 1419i4rali, VlI;,r,.r i%. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ q®D' <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: A nti Cl&,,,,,,T (‘0141- 56Guyz try fir—;4 <br /> • . CONTACT INFORMATION . _ . . . <br /> OWNER NAME: P1i1L l*S'Te/ TENANT NAME(If Commercial): Same <br /> OWNER MAILING ADDRESS: STREET 1 O ? I1e GLGe4e. AV/2 <br /> A Q <br /> CITY IZ VtI!i I I STATE / ZIP ` 1.2.®1 <br /> OWNER PHONE: 1-i 2.c-25.2 - Li la" OWNER EMAIL: es t.�p,,o L1,;L ip @. y�dtio-.Cpv,. <br /> CONTRACTOR NAME: Dahl Electric, Inc. <br /> CONTRACTOR ADDRESS: STREET 3409 McDougall Ave . <br /> ,I,, Everett STATE WA zip 98201 <br /> CONTRACTOR PHONE: 425-252-1700 CONTRACTOR EMAIL: dstevens@dahlelectric.com <br /> CONTRACTOR LIC.#(REQUIRED): DAHLEE1926QD 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:I 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 I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> a Ab..."..." 3.. 3- 1 -7E110 - b'n <br /> Owner/Authorized Agent Signature Date . . , (Revised 9/23/2016) <br />