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grr ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:`/;:(ltj ?Ara , - <br /> BUILDING AREA(if residential,new construction, remodel,or addition) - SF <br /> BUILDING TYPE: FR-DETACHED ❑SFR ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 12„4.) ;\1,4(; I a ! <br /> ELECTRICAL APPLICATION INFORMATION <br /> • <br /> CONTRACT PRICE OF WORK:$ .�j5 1i <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> DESCRIPTION OF WORK: ,.EJfFtrplIr,14-i( n. -+;- 1 ;tk�. EYitil;� Qec/0 ii3,7\0,t ( sit <br /> CONTACT INFORMATION <br /> OWNER NAME: LCzitt 4i694-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET VJOq '2, rd S.- <br /> CITY Fit'?ir-�' STATE ViirOi ZIP q.'I r 20 i <br /> OWNER PHONE:14as-- - OWNER EMAIL: <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 Gd CONTRACTOR 0 OTHER(Please Specify) <br /> • <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Ali 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 properly 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 /> _ 9- Q J ; . - - E 11 9) <br /> �a�-- <br /> Ow eeriAuthorized Agent Signature Date (Revised 923/2016) <br />