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Jun. 19. 201711 : 38AM • No. 5461 P. 2 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810 - FAX 425-2578857 —www.everettwa.org <br /> *-ta(A PcrP -- fir <br /> PROJECT ADDRESS <br /> TO1Y110 R1 it @f- a -1 Po i- <br /> of ao3 <br /> Owner Mail Address City Slate/Zip Phone <br /> -Satv\i ( Soubcv4 <br /> Tenant Mall Address City State/Zip Phone <br /> G&S HEATING 3409 EVERETT AVE EVERETT, WA 98201 425-252-4402 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> GSSHTGSH939RK 019685 <br /> State License Number(required) City of Everett Business License Number(required) <br /> RESIDENTIAL c lF <br /> Proposed Use of Building Contract Price of Work <br /> 3cn 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[ow voltage) �� n <br /> Description of Work to Be Done: P ftJ u L rho/10i; aC1nryvp <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 , • sOC <br /> I hereby certify that l have read and examined this application and know the same to be true and I �� <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 n <br /> performance of construction. That I am authorized by the owner of this property to perform the EO1/n-1 I n3ork for which application is made and I comply with the State Contractors Law 18.27 RCW and l V� <br /> 296.200 WAC. <br /> ja/1/0. (0- lq - <br /> Signature Date <br /> REVISED OE1'16/2014 <br />