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,t,, i, <br /> A <br /> ,IIIIIIP t <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 f FAX:425-257-8887 <br /> (E)everettepseeverettwa gov I www.everettwagflv/permits <br /> . . <br /> PROJECT ADDRESS � .... �� y <br /> BUILDING AREA(if residential,new construction,remodel,or addition) <br /> SF <br /> BUILDING TYPE: 121.SFR DETACHED 0 SFR-ATTACHED0 DUPLEX CI MULTI-FAMILY-#OF UNITS: <br /> USE OF BUILDING: S,FR . 0 COMMERCIAL <br /> K <br /> CONTRACT PRICE OF WORK;$ 350 " s k,_ «... <br /> NUMBER,OF DEVICES if low voita,e <br /> FIRE ALARM? Q YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if a,siicable : M1805-053 <br /> DESCRIPTION OF WORK; 4 ZONE DUCTLESS HEAT PUMP <br /> i " A± NTA T 1NFOR T4 <br /> OWNER NAME:NIGEL <br /> Mal1"1'1 . l <br /> TENANT NAME If Commercial <br /> OWNER MAILING ADDRESS: STREET SAME AS SITE ADDRESS <br /> OWNER PHONE:IIIIIIIIIIIIIIIIIIIImmmnm.o60-453-7890 <br /> OWNER EMAIL:N/A 11 <br /> CONTRACTOR NAME: BLACK LION HEATING &AIR CONDITIONING <br /> CONTRACTOR ADDRESS: STREET 11 001 118TH PL.NE <br /> cm,KIRKLAND <br /> CONTRACTOR PHONE:4258143944 CONTRACTOR <br /> WA zip 98033 <br /> CONTRACTOR EMAIL; BRENDA@BLACKLIONHVAC.COM <br /> CONTRACTOR L!C<#(RECtUtREd?): BLACKLH$73QQ <br /> CITY OF EVERETT BUSINESS LIC,. iRauIREa:053541 { <br /> PRIMARY CONTACT: .0 OWNER 121 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> BRENDACONTACT PHONE: 4258143944 <br /> CONTACT EMAIL:BRENDA. BLACKLIONHVAC.COM k' <br /> AGREEMENT:I hereby certify that I have read and ekamined 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 �n(i <br /> local law regulating construction or the performance of construction. That!am authorized 011ie owner of this property to perform the work for which application is made and <br /> g ng ofa permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> comply with the state Contractors Law 18.27 RCWand 291..200 WAC fr pay <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E (i- 2 <br /> 4 .' ) <br /> Aut Agent _ r5 <br /> Gate (Revised 9123/2015) <br />