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477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwagov www.everettwa.gov/permits <br /> PROJECT SITE IINFORMATION <br /> PROJECT ADDRESS: } 1,3 Fp , td 1:€2i cA I Ali 6ire'' vo o <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 1(0O SF <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION :: <br /> CONTRACT PRICE OF WORK: $ _/ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: kP fa U- +n4 i a 11 <br /> l t P <br /> CONTACT:.:INFORMATION .. .. <br /> OWNER NAME: ( a`¢ `j—,�'icy) L..%lc TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1331 3 1 ezio--rf [c )Ale- <br /> C3TY AI jSTATE ZIP <br /> i <br /> OWNER PHONE: 4-1:5 ,-� — 3 7.7 OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE Q <br /> CITY 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: I]OWNER 10 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT:l hereby certify that I 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 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 /> lit5) <br /> !UPI E S - <br /> Owner% uthorize.Acddnt 3rgnature Date (Revised 9/23/2016) <br />