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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 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1308 Grand Ave Everett WA <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2949.00 <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: retro t-Stat and reconnect furnace <br /> CONTACT INFORMATION <br /> OWNER NAME:Nancy He land TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1308 Grand Ave <br /> CITY Everett STATE WA Z,, 98201 <br /> OWNER PHONE: 4255-3355-4029 OWNER EMAIL:nordstromha@COmcast.net <br /> CONTRACTOR NAME: Nordstrom Heating & Air Inc. <br /> CONTRACTOR ADDRESS: ITIEET4717 87th Ave NE <br /> C,,Marysville STATE WA Z,, 98270 <br /> CONTRACTOR PHONE:4255-3355-4029 CONTRACTOR EMAIL: nordstromha@Comcast.net <br /> CONTRACTOR LIC.#(REQUIRED): nordsha884JW ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):042741 <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-335-4029 <br /> Jason or Debbie CONTACT EMAIL:nordstromha@comcast.net <br /> AGREEMENT l hereby certify that I have read and examined this application and know the same to be true and correct. Alt provisions of taws 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 property to perforin the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Debbie Elgin - p -- "7 El�dl� D <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />