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�CTRICAL PERMIT API' --lCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: � '�I "�`,',� ' � �" ' � � � r � � <br /> BUILDING AREA(if re ential, new construction, remodel, or addition) SF <br /> BUILDING TYP�; SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> � , � <br /> USE OF BUILDING: �' " <br /> ''+�.tt`l'e,_�i�'S�1�,�.' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ---- <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if ap licable : <br /> DESCRIPTION OF WORK: , �� �, , ' - '� <br /> CONTACT INFORMATION <br /> OWNER NAME''� .�� ~ L� v TENANT NAME(If Commercial): <br /> J <br /> OWNER MAILING ADDRESS: sTREET � a (,`,;;-L;� <br /> CITY �� L�,�\ G�� � �1 STATE ZIP <br /> OWNER PHONE: �1 � �.(�j — �� ��' �' OWNER EMAIL: <br /> coNrRacroR NannE: G&S HEATING <br /> CONTRACTOR ADDRESS: sTReer 3409 EVERETT AVE <br /> c,T,, EVERETT STATE �NA z�P 98201 <br /> CONTRACTOR PHONE: 425-252-4402 cotvTRa,cTOR Ennai�: DAWN@GSHEATING.COM <br /> coNTRacTOR�ic.#�REQuiREo�: GSHTGSH930RK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O�9685 <br /> PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER coNTACT Ennai�: DAWN@GSHEATING.COM <br /> AGREEMENT:I hereby certify thaf/have read and examined this application and know the same to be true and correct. Al/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 1 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 /> `�� - � <br /> �_ --, � � E � �1 IZ � <br /> Owner/Authorized Agent Signature D te (Revised 9/23/2016) <br />