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�ECTRICAL PERMIT AP�ICATI4N <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (F}425-257-8810 � FAX 42�-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gavlpermits <br /> > `P.ROJECT'SITE INFORMATION : <br /> PROJECT ADDRESS: (.{� PL S� <br /> BUILDING AftEA(if resi ntial, new construction, remodel,or addition) gp <br /> BUILDING'I`YPE: SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#4F UNITS: ❑ COMMERCIAL <br /> USE OF BUILDENG: � <br /> ` ELECTRICAL APPLICATtON 'INFORMATION ! <br /> CONTRAC7 PRICE OF WORK: $ 1 ' . (} ` <br /> NUMBER OF DEVICES (if low volta e : , <br /> FIRE ALARM? ❑YES Np <br /> ASSOCIATED BUILDING PERMIT# (if a plicable : <br /> DESCRIPTION OF WORK: � <br /> 'CONTACT'INFORMATtON <br /> OWNER NAME: � Y" � TENAN't NAME{If Commercial): <br /> OWNER MAILING ADDRESS: sTReer t �{ <br /> Cm STATE ZIP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRAC70R ADDRESS: sTReer 3�09 EVERETT AVE <br /> cin. EVERETT sTnre WA zia 98201 <br /> CONTRACTpR PHONE: 425-252-4402 coNrRacroR EnnAit�: DAWN@GSHEATING.COM <br /> CONTRACTOR LIC.#(REQUfRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): p�986� <br /> PRIMARY CONTACT: ❑OWNER �CQNTRACTOR ❑�THER(Please Specify) <br /> CONTACT NAME: COHTACT PHONE: 425-252-4402 <br /> DAWN WEIMER coHTacT EM,ai�: DAWN@GSHEATING.COM <br /> AGREEMENT.�i hereby ce�tify thaf!have read and examined this applicafion and know fhe ssme to be hue and correcf. A!!provisions of laws and orrlinances goveming thrs type <br /> of work wi!!be completed whether specified herein or not. The granting of a permit does not presume to gr`ve authorify to vrolafe or cance!the provisions of any other stafe or <br /> loca!!aw regulating construction or the performance of consfruction. 7hat!am authorrzed by the ownerof this p�operfy to perform fhe work for which application rs made and! <br /> compJy wilh the Sfate Contractors Law 98.27 RCW and 296200 WAC. <br /> ! <br /> ' City of Everett Officia!Use Only <br /> PERMIT# <br /> ��z.�cn E l� cc - � � S <br /> OwnedAuthorized Agent Signature Date (Revised 923/2016) <br /> _ .... _... . .. .... _._ _ . __._ _ _.. <br />