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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 ( (E) everetteps@everettwa.gov( www.everettwa.gov/permits <br /> €PROJECT:': <br /> S <br /> .....:...:: <br /> PROJECT ADDRESS: 329 51ST ST SW <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: Pl SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: RESIDENTAIL <br /> CONTRACT PRICE OF WORK:$ 2000 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ®NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: REPLACE GAS FURNACE <br /> C N. : <br /> O TACT:4: N <br /> OWNER NAME:JAKE BERGEVIN TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 329 51ST ST SW <br /> cny EVERETT STATE WA zip 98203 <br /> OWNER PHONE: 4252586093 OWNER EMAIL: <br /> CONTRACTOR NAME: GS HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cnv EVERETT STATE WA ZAP 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM <br /> CONTRACTOR LIC.#(REQUIRED): GSH EAHC82I 8R CITY OF EVERETT BUSINESS LIC.#(REQUIRED):60058 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT:l 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 I em authorized by the owner of this property to perform 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 /> 2/6/2019 E 03° <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />