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,► 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 1 www.everettwa.govipermits <br /> _ :;:. .:. . ... A ION.. .::::::: . ....... ...: ::.:...:: . ...:.::. <br /> PROJECT ADDRESS:25-1 1910,/I;i fir? <br /> BUILDING AREA(if residential, new construction, remodel,or addition) ri, i'�;I SF <br /> BUILDING TYPE: 2 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Rs rr c inie 4 : <br /> CONTRACT PRICE OF WORK:r-- r t 7 �Av 16?).tOS <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: LillSi"C l`t I)4 trice i i•€ no 1,Ai no+Ci n 4- I 1 a 4 t?.srui '4R Yin <br /> ( nu i; SQ('Va(.x ( I4 uc)- •... <br /> :.. . CONTACT INFORMATION <br /> OWNER NAME: Mk)f .i ()I 11 I,0m()i y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j� . t)0 i i d <br /> CITY f i ofireT Y STATE WA ZIP CI ,( •'j <br /> OWNER PHONE: ,- -(C,=QQ OWNER EMAIL: Sl r)(2,, s.& i-t'fcii APt_.C - <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> CITY 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 17 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 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 1 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 /> RA Lk 0, - o . 5 E( �d11- 013 <br /> Owner/Authorized Agent Signature Date (Revised 9123/2016) <br />