916 PACIFIC AVE BASE FILE 2019-04-29

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ( )Of C.14 IC- >4Vi BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: LKCOMMERCIAL USE OF BUILDING: T {r'- 'v}rA y ECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ al O DO°i NUMBER OF DEVICES(if low voltag:): FIRE ALARM? 0 YES I NO ASSOCIATED BUILDING PERMIT#(if a.•!cable): DESCRIPTION OF WORK: iqAD ag - Y /2./,E CIS,01-41 ce r S . • CONTACT INFORMATION . .. • OWNER NAME: it T1414 Ivy N TENANT NAME(If Commercial): Same OWNER MAILING ADDRESS: STREET P/j /5 le I a,� Lift' /� CITY E. T /-STATE L. ZIP -/sa D OWNER PHONE: r) - Lo3 S'D OWNER EMAIL: ele lOfy._� efh 1,11.4/. Orej CONTRACTOR NAME: Dahl Electric, Inc. CONTRACTOR ADDRESS: STREET 3409 McDougall Ave cm, Everett STATE WA zip 982 CONTRACTOR PHONE: 425-252-1700 CONTRACTOR EMAIL: dSteVerlS C@dahleleCtriC.COM CONTRACTOR LIC.#(REQUIRED): DAHLEE1926QD CITY OF EVERETT BUSINESS LIC.#(REQUIRE ): 037024 PRIMARY CONTACT: 0 OWNER VI CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-661-0511 Dan Stevens CONTACT EMAIL: dstevens@dahlelectric.com 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 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 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 Comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# E 2- 12 (4:2 Owner/Authorized Agent Signature Date (Revised 9/23/2016)