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Dec, 29. 2016— 9 : 08AM No, 4626_P. 1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 FAX 425-257-8857—www.everettwa.org <br /> PROJECT ADDRESS <br /> Owner Mall Address City State/Zip Phone <br /> Tenant Mail Address Clty State/Zip Phone <br /> G&S HEATING 3409 EVERETT AVE EVERETT, WA 98201 425-2524402 <br /> Electrical Contractor Maii Address City State/Zip Phone <br /> GSSHTOSH939RK 019685 <br /> State License Number(required) City of Everett Business License Number(required) <br /> RESIDENTIAL <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: <br /> FEE /l <br /> CITY OF EVERETT FOCAL SALES TAX CODE 13 3105 Qv�� <br /> I hereby certify that I have read and examined this application and know the same r <br /> PP 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 98.27 RCW and Y <br /> 296.200 WAC. <br /> Signa ure ate <br /> REVISED 08/06/2094 <br />