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OLT 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT:SITE;INFORMATION <br /> PROJECT ADDRESS: ‘5,<, 71 c <br /> BUILDING AREA(if resi�-ntial, new construction, remodel,or addition) SF <br /> BUILDING TYPEr$ FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: ki+).� ;?U,1 <br /> ;EI ECTRIICAL APPUCATION:INFORMATION <br /> CONTRACT PRICE OF WORK:$ 20(i O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ..21<0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: K-Lc':as : 4, <br /> CONTACT.;INFORMATION <br /> OWNER NAME: res.;;vr.; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '{,72---?,.N vkA.; ( . <br /> n 2lai SF .s?rl <br /> CITY c .?' i STATE S5 <br /> ZIP s <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE t1 <br /> cm 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): 019865 <br /> PRIMARY CONTACT: 0 OWNER Qi 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 heroin 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 t am authorized by the owner of this property to perforin 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 /> rr , � E 039- <br /> Owner/Authorized Agent Signature Date (Revised 9123/2016) <br />