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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 ( (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: L'i s _ FDA-- <br /> BUILDING <br /> —BUILDING AREA(if residential, new construction,remodel,or addition) 1 t%1(f} SF <br /> BUILDING TYPE:•,FR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: R.es r (i,y`1rr'.p <br /> '.ELECTRICAL APPLICATION INF',ORMATION ;; <br /> CONTRACT PRICE OF WORK:$ i•9 '7, (17) <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ap• ,(tw(a;C i `�.7�illr cover QI',r - :7fV•lro . Y rr,lot <br /> c( y 0cm.0 <br /> S 4? N.n( l-)n ry0 .0 C:`a f i irm?e r . <br /> tCONTACT:.INFORMATION ....... <br /> OWNER NAME: n1i i,;•, r I ,Q,n I; I,(Y v .rx. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY F_`if re A-4:- STATE ZIP 2 )r) <br /> OWNER PHONE:eqfl(r)-1 -'I— OC OWNER EMAIL: NIViiric7 l/a.LI ��hOirt b'‘(;t lir C r2 <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> CITY EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATI NG.COM <br /> CONTRACTOR LIC.#(REQUIRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685 <br /> PRIMARY CONTACT: 0 OWNER ®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 em authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> it . I 1-ot-1 E SS(A — OTCI <br /> Owner/Authorized Agerrt Signature Date (Revised 9/23/2016) <br />