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Dec, 16. 2016_ 2 : 50PM No, 4563 P, 1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES (zliw <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> G&S HEATING 3409 EVERETT AVE EVERETT, WA 98201 5-252-4402 <br /> Electrical Contractor Mail Address city Stat Zip Phone <br /> GSSHTOSH939RK 019685 <br /> State License Number(required) ity of Everett Bus" less License Number(required) <br /> RESIDENTIAL (1✓1 1(Vv2C�n.�_ <br /> Proposed Use of Building Contract Price of Work <br /> DAWN WEIMER 425-252-4402 <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: IJU xtl- ` <br /> FEE <br /> CITY OF EVERETT LOCAL.SALES TAX CODE IS 3905 /'4s - <br /> 1 <br /> I hereby certify that I have read and examined this application and know the same to be true and �[ <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the ( <br /> performance of construction. That I am authorized by the owner of this property to perform the E <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> "/ z W [c.o <br /> Sig ure Date <br /> REVISED 08ID62014 <br />