10332 21ST AVE W 2019-06-12 - Laserfiche WebLink

Nov. 19. 2018 4: 18PM No. 7271 P. 1 IOECTRICAL PERMIT AP !CATION CITY OF EVERETT PERMIT SERVICES �1► 3200 CEDAR STREET, EVERETT, WA 96201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10332 21st Ave W BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX El MULTI-FAMILY #OF UNITS: ❑ COMMERCIAL USE OF BUILDING: SINGLE FAMILY RESIDENCE URGENTIIIIIIIIWWIIIUU ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage): URGENTI!III! FIRE ALARM? ❑YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: REPLACE METER BASE URGENT!!! • CONTACT INFORMATION • OWNER NAME: HILARY FORMAN TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10332 21ST AVE W c,rf EVERETT STATE WA ZIP 98.204 OWNER PHONE: 425-231-3279 OWNER EMAIL: • CONTRACTOR NAME: G&S HEATING CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE o,r. EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN ix@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685 PRIMARY CONTACT: ❑OWNER VI CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-252-4402 DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM AGREEMENT:I hereby certify that I have road and examined this application and know the same to be true and correct, All pmvlslons of laws and ordinances governing this type 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 local law regulating construction or the performance of construction. Thal I am authorized by the owner of this property to perform the work for which application Is made and I comply with the Slate Contractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only PERMIT# E '#)\\. '1"* OwnerlAuthoriz:r APCF t Signature Dale (Revised 9/23/2016)