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eilli*"./%E-AELECTRICAL PERMIT APPLICATION <br /> .4./ . � 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 SITE INFORMATION <br /> PROJECT ADDRESS: 1,()C) \;,r4-G4'1 i Gam. <br /> r <br /> BUILDING AREA(if reidential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS:is <br /> 0 COMMERCIAL <br /> USE OF BUILDING: c;'J/»/I.O9/i '1n7 0 <br /> ELECTRICAL:APPLICATION INFORMATION <br /> • <br /> CONTRACT PRICE OF WORK:$ 4(0'3 <br /> NUMBER OF DEVICES (if[ow voltage): <br /> FIRE ALARM? 0 YES ,1N0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> n t <br /> DESCRIPTION OF WORK: d t\ L . KIS, '2 T') (±r\rr�0 r ktl' >tiaj r0_,(4) - <br /> CONTACT INFORMATION <br /> OWNER NAME: (INr.m.jOO VI1?,a TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Iii QayVvw'$a.; <br /> CITY e'(hQiEy,yt. STATE r A A. ZIP °Oz5I, <br /> OWNER PHONE: '(7\-1\'r}-- 5()01" . OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: sTREET 3409 EVERETT AVE <br /> crry 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 QI 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 1 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 298.200 WAC. <br /> City of Everett Official Use Only <br /> 1. PERMIT# <br /> %'` 5"1-1 1 lg E 105- Vl< l <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />