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4ELECTRICAL PERMIT APPLICATION
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov1 vvww.everettwa.gov/permits
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<br /> PROJECT ADDRESS: Z.46. '\,,,I-p,r•Q., IN,
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<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: liSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
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<br /> USE OF BUILDING: ..i_p_/‘ 4
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<br /> ELECTRICAL APPLICATION 1NFORMATION.::::::::0;k,::::::::::::g;',:.„.;•:::!;:E:::,::iiFi:',.,:.-::::;::::::,;:aii,•;!::;E: :;:,:,,9: ::: :::;,:iliJ
<br /> CONTRACT PRICE OF WORK:$ It OD c(573.
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES /A NO
<br /> ASSOCIATED BUILDING PERMIT#(if.applicable):
<br /> DESCRIPTION OF WORK: r i‘,,,,,AN 0 (-1--- 6 ou_du.../..-/\_. . :; • ;
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<br /> OWNER NAME: Slr V\ 'ik Ai‘610,A_-k— TENANT NAME(If Commercial):
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<br /> OWNER MAILING ADDRESS: STREET '3\Al( \ <V\
<br /> en, Sun I A- 410.") STATE ;ZIP
<br /> OWNER PHONE: ‘-1,-1,7K-- 0—NCR OWNER EMAIL:
<br /> CONTRACTOR NAME: G&S HEATING
<br /> CONTRACTOR ADDRESS: eraEer 3409 EVERETT AVE
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<br /> EVERETT STATE WA I zip 98201
<br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM1 —
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<br /> CONTRACTOR LIC.#(REQUIRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-252-4402
<br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM 1 :,•, : :,
<br /> AGREEMENT:I hereby certify that!have read and examined this application and know the same to be true 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!
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<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WPC.
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<br /> City of Everett Official Use Only
<br /> PERMIT# i
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<br /> 1E1, 6-.),,il . lb '1 . Hi
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<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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