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ELECTRICAL PERMIT APPLICATION <br /> I*►' y CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> > _:: PROJEGT:•SITEINFORMATION:;> <br /> PROJECT ADDRESS: 41 E;1 ch/AAAA <br /> BUILDING AREA(ifrepidential, new construction, remodel,or addition) SF f <br /> BUILDING TYPE: l!1SFR-DETACHED ❑SFR,ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: �J,Z,,,fy��ti../k1 .� <br /> >:.. ,. , ,.E4ECT 1CAL:APPL'ICATION"INFORMATION. <br /> CONTRACT PRICE OF WORK: $ I 0 0 00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 1:;1/NO <br /> ASSOCIATED BUILDING PERMIT#:(if applicable): <br /> DESCRIPTION OF WORK: c2-4,.Pi N1,7 o�,A4 ‘ acc - <br /> a <br /> CONTACT:INFORMATION <br /> OWNER NAME: '(J (;;!`R� i� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr -t4` lI <br /> CITY 'jj y STATE t....1,4k ZJPX�1 <br /> OWNER PHONE: ..41 OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cry EVERETT STATE WA zlp 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM <br /> CONTRACTOR LIC.#(REQUIRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685 <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT;1 hereby certify that l have read and examined this application and know the same to be free 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 /> \ 11(‘ Eitbbl- <br /> � <br /> Owner/Authoiizd Agent Signature !Date (Revised 9/2312016) <br />