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-Art,- <br /> CITY <br /> '` ELECTRICAL PERMIT APPLICATION <br /> � CITY Op <br /> EVERETT PERMIT SERVICES <br /> CEDAR{p}425-257-8810 I FAX 425-257-8853407 ({E}a RE ET,VERETT, <br /> @ eret WA svw <br /> tWa.gCY wvvw,everettwa.gov/permits <br /> PROJECT ADDRESS. 1410 W • <br /> , R 'Rt? •t4, F®,RMATlOr <br /> BUILDING AREA(if residential Casino � On i4������� � ;q <br /> new construction,remodel,or addition) <br /> BUILDING TYPE: Q SFR-DETACHED SF <br /> SFR-ATTACHED 0 DUPLEX QMULTI-FAMILY..#OF UNITS: <br /> Q COMMERCIAL <br /> use OF BUILDING: residential <br /> 350 O ' <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES if low volta•e : <br /> FIRE ALARM? 0 YES <br /> 0 NO <br /> ASSOCIATED BUILDING PERMIT# if a4•licable : M1805-001 <br /> DESCRIPTION OF WORK: Ductless Heat Pum, <br /> '.., F . cO TACT INFORMATION .' x <br /> OWNER NAME:Nicholas Johnson <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET same as site address <br /> CITY <br /> OWNER PHONE: 360-320-0454 STATE ZIP OWNER EMAIL:n/a <br /> CONTRACTOR NAME: Black Lion Heating &Air Conditioning <br /> CONTRACTOR ADDRESS: STREET 11001 118th pl ne <br /> CITY Kirkland STATE wa <br /> zip 98033 <br /> CONTRACTOR PHONE:4258143944 (CONTRACTOR EMAIL: brenda@blacklionhvac.com <br /> CONTRACTOR LIC #REQUtRED: blacklh$73gq CITY OF EVERETT BUSINESS LIC.#(REQU ED) 053541 <br /> PRIMARY CONTACT: Q OWNER ca CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-814-3944 <br /> Brenda CONTACT EMAIL:brenda(aablacklionhvac.com <br /> AGREEMENT'I hereby certify that I have read and examined this application and know the same to be true and correct. Ali 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 #o give authority ro violate or cancel the provisions of any other stela or <br /> local law regulating constriction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is mads and 1 <br /> comply with the State Cont-actors Law 1827 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> gr;ifr <br /> , iiikk,. / <br /> r 4 G. I . 11,1t, <br /> PERMIT# <br /> E I c605- 00e <br /> Owner rather' 4. <br /> ,ent S gnature Date (Revised 9/23/2016) <br />