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-: �58 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 10128 23RD DR SE, EVERETT WA 98208 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: VL SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATIONINFORMATION <br /> CONTRACT PRICE OF WORK: $1,200 <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ❑YES Z NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: <br /> GAS FURNACE AND A/C INSTALL <br /> CONTACT INFORMATION <br /> OWNER NAME: CYNTHIA ABRAHAMSON TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10128 23RD DR SE <br /> CITY EVERETT STATE WA zip 98208 <br /> OWNER PHONE:425-478-2632 OWNER EMAIL: <br /> CONTRACTOR NAME: MM COMFORT SYSTEMS <br /> CONTRACTOR ADDRESS: STREET 18103 NE 68TH ST SE, C-200 <br /> CITY REDMOND STATE WA ZIP 98052 <br /> CONTRACTOR PHONE.425-881-7920 RACTOR EMAIL:PERMITS@MMCOMFORTSYSTEMS.COM <br /> CONTRACTOR LIC.#(REQUIRED):MMCOMCS847P4 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED) t(# + <br /> PRIMARY CONTACT: ❑OWNER CS CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-881-7920 <br /> DAVID CLU ETT CONTACT EMAIL:PERMITS@MMCOMFORTSYSTEMS.COM <br /> AGREEMENT:T 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 <br /> type 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> f PERMIT# <br /> E 1 <br /> r U�l/ G/ B-4-17 <br /> Date (Revised 10/12/2015) <br /> Owner/Authorized A nt Signature <br />