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4rETT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT.SITE INFORMATION <br /> PROJECT ADDRESS: .7.2.)" S Vtu;�(� d� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED� 01 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: A 1 ^1A. v' : <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ---- <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES gi NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: L a,016,4-L)(4.--, <br /> u' <br /> CONTACT INFORMATION <br /> OWNER NAME: std I, ,{� (Lia pol TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREE-r -� ' 4 Sr _ <br /> CTY .. ) Q.4)JtiU STATE /.. / ZIP 6- <br /> OWNER <br /> OWNER PHONE: g OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cr.,. EVERETT STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM <br /> CONTRACTOR LIC.#(REQU1RED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685 <br /> PRIMARY CONTACT: 0 OWNER IdI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 • <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> t•it,P?st E <br /> Owner/Authorized Agent Signature Date ' (Revised 9/23/2016) <br />