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CTRICAL PERMIT AF ..ICATION <br /> +^' 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: 18/14 0 a pie s+ 60-Ciretr IA14 'e 61 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) (/L p SF <br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ PG <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT (if applicable): <br /> DESCRIPTION OF WORK: Q !GC@ e2(X) r P /y•yei ( o nr✓ <br /> CONTACT INFORMATION <br /> OWNER NAME: ? Q.J-I t LIh - bP/j- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c2� N rip)2 c -3-- <br /> _ WA96;: C.....)11 <br /> 11(91",— <br /> CITY �).p�'� STATE ZIP <br /> OWNER PHONE: `7d1"," 307 r €9-1 TI L OWNER EMAIL: 5f) ' Ippj( ) r)-Icx. corn <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cin 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 ® 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 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 /> 10/3061 E -CO <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />