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ELECTRICAL PERMIT APPLICATION <br /> ^`' y CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov J www.everettwa.govlpermits <br /> RO <br /> J T: <br /> EC <br /> SAYE.i <br /> ...::..;:..,::..:::.:::.:,:..:- <br /> PROJECT ADDRESS: - d n 0,\14,— <br /> BUILDING AREA(if fesidential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ill SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDIN�' �sKJI ,�Eo1.� J ri• _, <br /> ,i� a 17 <br /> ELE` <br /> CT.RIC <br /> AL;AP.P :1 <br /> L <br /> CATION <br /> 1NF0 <br /> R <br /> . ....:.......... . . <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): • <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(I applicable): <br /> DESCRIPTION OF WORK: Cjg2 TA f( ems <br /> N .,. <br /> TACT. <br /> ()RMATI <br /> OWNER NAME: '..iit.e.s`�i i 11 titida it TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE L014 ZIP Ctcan. I <br /> OWNER PHONE: n,ctNZ GB 1, , OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cry 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: ❑OWNER CZ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM <br /> AGREEMENT:1 hereby certify that!have read and examined this application and know the same fo 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!am 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 /> ir m n E <br /> Owner/Atithorized Agent Signature ate (Revised 9/23/2016) <br />