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-01ETT ECTRICAL PERMIT AI}_ICATION <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@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITEINFORMATION <br /> PROJECT ADDRESS: 1 Q QX <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: SFR-DETACHEDnw0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDI G: Wt1 Lt "1 '� <br /> VV_"V 1 ELECTRICAL APPLICATION INFORMATION ',"° 1";� t`°(�" �'` <br /> CONTRACT PRICE OF WORK: $ J °Lop <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if a plicable): <br /> DESCRIPTION OF WORK: tau -flyInaab <br /> CONTACT INFORMATION . <br /> OWNER NAME: Cs�l,t �,(/1.v.- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:' ' STREET .c.-}l G azeo <br /> cin, I.Wk(jA STATE (144 ZIP <br /> OWNER PHONE: OWNER EMAIL: HHtl��, <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> tiny 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): 019865 <br /> PRIMARY CONTACT: 0 OWNER r21 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 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 I 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 /> __"1... <br /> -- (6)i' 1( n E 171 1 i - OD <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />