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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT ADDRESS: 2"l-9-i r7\;\ C 1 'kok A L, <br /> • <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ISFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: \ 4\ ''t;.(Lk <br /> >ELECTRicAI <A!.!L . <br /> ICAT ON": <br /> CONTRACT PRICE OF WORK:$ 1T, O <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? D YES i i o <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: (NtiOt n(-k hsw ,-L <br /> • <br /> TACT:INFORM . . <br /> OWNER NAME: C Cor( \ ( . �� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> crre A IAA-.4- STATE LCR--1 ZIP G5,.2,1;)t <br /> OWNER PHONE: L'11.:),''3e, aft A OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: sTRaEr 3409 EVERETT AVE <br /> on, EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM <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 <br /> AGREEMENT I hereby certify that 1 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 lam authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> -141 ( 7 E 1 %0Li -00 ( <br /> Ociner/Autfiezimi.Agelit Signature bate (Revised 9/23/2016) <br />