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<br /> ELECTRIGAL PERMIT APPLICATION
<br /> CITY QF EVERETT P�RMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov( www,everetfwa.gov/permits
<br /> ,. ' ; ,.:.. , - PRO�ECT;:SITE<;IN�'ORMA'TION :..
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<br /> PRQJECT l.1DDRESS: "'l?�;� �,���,��� ,�
<br /> 8E11LDING AREA(if re.,sidential, new construct�on, remodel,or addition} SF
<br /> BUILDING"fYPE: f SFF2-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
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<br /> USE pF BUILDING: �J��:�p�.���
<br /> '::`,`;i`::ELECT
<br /> RICAL::APPL
<br /> ICAT ON'.' N�'
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<br /> CON'fRACT PWCE OF WORK:$ ��j_G'���
<br /> NUMBER OF DEVICES rF low uolta e :
<br /> FIFtE ALARM? ❑YES dN0
<br /> ASSOCEATED BUILDING PERMIT# 9f appficable :
<br /> DESCRIPTION OF WORK: �1v;.��,�(' ��;�^i�r,,�,�,��,
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<br /> CONTACT,.I ORMATION
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<br /> OWNER NAME: '�;{,+.,,�;t�.;i'� j,��?,�,;,v�.�fJ'�`�- TENANT NAME(If Commerciaq:
<br /> OWNER MAILING AdDRESS: sr�t�21' �,��� �^ta�k� �Glo ��".��"'
<br /> CITY �/� yt�L .i�4 STAIE : ,"'✓�" ZIP -1+i,�//.�'�
<br /> OWNER PNONE: 'v;'r h�� ' �--- '�` ^, i
<br /> � `,��; ,� OWNER EMAIL:
<br /> co�tr�aC'roR NamE: G&S HEATiNG
<br /> coHrRacTotz a,���ess: s���3409 EVERETT AVE
<br /> c�T. EVERETI' SrAr� WA ziP 9820'1
<br /> CON7RACTOR PHONE: 425-252-4402 coNTRacTOR e�n�u�: DAWN@GSHEATING.COM
<br /> cotv�t�,cTOR��c.�tReQutReo�: GSHTGSN930RK CITY OF EVERETT BUStNESS LIC.#(REQU[RED):���6gS
<br /> PRIMARY CON7ACT: �OWNER (,L!CONTRACTOR ❑pTHER(Please Specify)
<br /> CONTACT NAME: CON'fACT PWONE: 425-252-4402
<br /> DAV1/N WEIMER co[rracr�ma��:pAWN@GSHEATI�IG.GOM
<br /> AGREEMENT.•l hereby terfify fhat 1 have read and ezamined this application and krrow the same to be we and cor�ect. Af!provisions of laws and ord;nances governing fhis type
<br /> af work wil!be comptefed wheN�erspecifred herein or noL The grantrng of a permit does nof presume Eo give authorify to violate or cance/the p�ov/sions ofany other state a
<br /> local law regulating conshcrc�tion or the perfnrmance of consfruction. Thaf!am authorized by the owner of fhis properly to perform the work for which application is made and!
<br /> comply with fhe State Contractors Law 78.27 RCW and 2s6.200 WAC.
<br /> Cify of Evareft O�cia!Use Only
<br /> � PERMIT#
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<br /> CV F V �
<br /> OwnerfAuthorized Agent Signature D a " (Revised 9/1320'!6)
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