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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E} everefteps@e�erettwa.gov� www.everettwa.gov/permits <br /> ` P'ROJECT SITE INFORMATION <br /> PROJECT ADDRESS; '`�- ; �� ` `�" ^ _S� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR A'1'fACHEd L7 DUPLEX ❑ MULTI-FAMILY-#OF UN[TS: ❑ COMMERCIAL <br /> `a� � <br /> USE OF BUILDING: � �,�''v�'l{;� <br /> ELECTRIGAL APPLICATION'IN�ORMATION <br /> CONTRACT PRICE OF WORK: $ '� ��; i,; �� <br /> NUMBER OF DEVICES if low volta e): <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILBING PERMIT# ifi applicable): <br /> DESCRIPTION OF WORK: ��'�^ � ; -� � eti � �^ � � <br /> CONTACT iNFC1RMAT10N <br /> OWNER NAME: " � �3 °�� � Y r TENANT NAME pf Commercial): <br /> OWNER MAILING ADDRESS: sTReeT � �;;�r " ^ <br /> ciTr �i 4`' _� � —Eo � � srarE zia <br /> OWNER PHONE: U�,�,� _ `�,._',., :'l� OWNER EMA1L: <br /> coNTw�cTOR HAME: G&S HEATING <br /> coNYR,acTOR ao�REss: sTReeT 3409 EVERETT AVE <br /> c,7,, EVERET7 s7a7E WA z,p 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CQNTRACTOR EMAIL: DAWN Q�GSHEATING.COM <br /> coNrRacTOR tic.#�REQu�REo�: GSHTGSH930RK CITY OF EVERETT SUSINESS LIC.#(REQUIRED): O�g6H�J <br /> PR[MARY CONTACT: ❑OWNER �CONTRACTOR ❑pTHER(Please Specify) <br /> CONTACT NAME: CON7AC7 PHONE: 425-252-4402 <br /> DAWN WEIMER coNracr Ennai�: DAWN@GSHEATING.COM <br /> kGREENEIVT:1 hereby cerfi(y that!have read and examined fhis application and know ihe same;o be true ana correct. k!(provisrons of laws and ordinances goveming this type <br /> of woric will be completed whether spec�ed herein or npt. 7he granting of a peimit does nof presume to give authonty fo violate or cancei the provisrons of any otherstafe or <br /> loca!law regulafing construction orthe performance of construCfion. That/am authorized by fhe owner of fhis property to perform the work fprwhiCh application is made and! <br /> comply wifh the Stafe Confractors Law i8.27 RCW and 296.200 WAC. <br /> City of Everett O�cia!Use Only <br /> � PERMIT# ` <br /> ' , � E ��� I �i �- <br /> OwnerlAuthorized Agent Signature D e (Revrsed 9/23/2016) <br /> _ _..._ _. _ __ <br />