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ELECTRICAL PERMIT APPLICATION <br /> "1111POI `, � CITY OF EVERETT PERMIT SERVICES <br /> �' 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> .;:.....:: ... ::.::.::.::PROJECT-SITE.INF ...- .,.............. <br /> ,.. :INFORMATION , , <br /> PROJECT ADDRESS: ''-)N3J 3/' Dr Ektare- (A)a 0 <br /> BUILDING AREA(if residential, new construction,remodel,or addition) i 1/1(.7& SF <br /> r <br /> BUILDING TYPE:' SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: ci) <br /> .: . . ... ....... ... *... ELECTRICAL APPLICATION <br /> >.;.:,,,:.,: ::::::::::.:: :::.;:.:;: :: :<:;-:: ::::: .:-... INFORMATION;:. . .,..:.:: . ::. :::.::: : :::':.:,;....::::::;;; : :::;: <br /> CONTRACT PRICE OF WORK:$ 4,0, <br /> ---- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable):` <br /> DESCRIPTION OF ORK: ' ' --C.<c- 4 I �P � (��E•i 'I— �t� f----_-., (91).P Q- <br /> / t-r-r, Al I Into <br /> . <br /> :.....CONTACT INFORMATION <br /> OWNER NAME: !.-A Lilo o i4 �1 Lcc r TENANT NAME(If Commercial): <br /> I �p <br /> OWNER MAILING ADDRESS: STREET . ) I y ,r 1 5� <br /> CITY A ,a ?"- STATE C/`)q ZIPet R19.-C) R <br /> OWNER PHONE: 14 ,p r" qcf 0-63 60 OWNER EMAIL: t:d s (-71055e,r ,,g ma i l 2 C,)) <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cry EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM <br /> CONTRACTOR LIC.#(REQUIRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685 <br /> PRIMARY CONTACT: 0 OWNER IZ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT:I hereby certify that 1 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 lam 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 /> r1 City of Everett Official Use Only <br /> IPERMIT# <br /> /1`� 11 <br /> i' �ti/1 +'0� �, 1 ` E I A013' <br /> OviineN/AttiorizedAge 't Sigkatu e v Date (Revised 9/23/2016) <br />