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Ap r, 19, 2017,10 ; 53AM No. 5179 P. 1 <br /> �LECTRICAL PERMIT PLICA�1 IVN <br /> C[-fY OF EVERETT PERM]T SERVIC�S <br /> 3200 CEDAR STREET, �VERETT, WA 93201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.evere#twa.gov/permits <br /> � PROJ�CT SITE INFORMA,�"ION <br /> PROJECT ADDRESS: ��`� <br /> SUIl.D1NC'a AREA(if residential, new construction, remodel,01'addition) SF <br /> eUILDfNG7YP�: SFR-DETACHED ❑SFR-ATTACHED (� DUPLEX ❑ MU�TI-FAMILY-#4F UNITS: ❑COMMERCIAL <br /> USE OF BUILDiNG: ^ <br /> EL�CTRICAL APPLI�ATION 1NFORMAT�ON <br /> CONTRACT PRiCE �F WORK: $ + O D � <br /> NUMg�R OF DEVICES ifr low volta e : <br /> FIRE ALARM? ❑Y�S ❑NO � <br /> ASSOCIA'TED BUILDING PERMIT# if applic�ble : <br /> DESCRIPTION OF WORK: i (�, <br /> CONTAC7 �NFOLRINATION <br /> OWNER NAME: \ 7ENAtdT NAME(lf Commercial): <br /> OWNER MAILING ADDRESS: sr�e�r �'[� S'�' S� <br /> ��N srATe ziP �'( <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAIW�: G&S HEATING <br /> CqNTRACTOFi ADDRESS: STRE�3409 EVERETT AVE <br /> �in EVERE7T srArE WA Zip 9$201 <br /> CONTRACTOR PHON�- 425-252-4402 COEVTRACTOR EMAlL: bAWN@GSHEATING.COM <br /> CONTRACTOR l.[C,#REQUIRED): GSHTGSF1930RK CITY OF EVERETT eUSINESS L1C.#REQUIRED: O�I 9H65 <br /> PRIMARY CONTACT: ❑ QWNER {�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425�252-44�2 <br /> DAWN WEIMER CONTACT�MAIL: DAWN@GSHEl�T[NG.COM <br /> AGREEMENT.�I hereby eartify that I Havs�ad and examined this appl+cat+an and know fhe same to be Erue end correct. a!1 provisions of laws end ordirrencas govsming tAis typa <br /> of work wiil be complefed whefher specifred herein or nvf. The grenting of a permit does not pr�suma to plve authorfiy to vielate or eance/the provrsrons of any other sfafe or <br /> loca!!sw regulating construcfion or the performanaa of eonsfrvetion. Thaf!sm authorized by the owner of fhis property to perlvrm the work for which applrcafivn ia mede end 1 <br /> comply w;th the SEete Contrectors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> y �� r� � E ��� - � 2� <br /> 1 <br /> Owner/Authori d Agent Signature Date <br /> (Revised 9/23/2096) <br />