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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 I www.everettwa.gov/permits <br /> ;PROJECT>SITE:'INFORMATION - <br /> PROJECT ADDRESS: 1 f/ f( 1 S-f-- i f2, 1 "I- (/)G (✓ (5).04.0 I <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: FR-DETACHEDr 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: 511 <br /> 1 <br /> ELECTRICAL.APPLICATION;INFORMATION: <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): r <br /> DESCRIPTION OF WORK: [ raj�- Cz {� Q 1 diL.G 1 ' Wire jj <br /> Pie,-C--7`r ( CCL I c7 e) Tri fit.tesla <br /> Dart?i I'vi 5-/, :. ;gyd nr, <br /> CONTACT.INFORMATION .. <br /> OWNER NAME: a dC? r? c Mv'I i tkc [ANT NAME(If Commercial): <br /> ss t f <br /> OWNER MAILING ADDRESS: STREET f { I I (p."11:41 ,$ <br /> 5 dry/} � <br /> j CITY y} �'' -H— STATE C A G g ZIP 9'7. 1(..)..) <br /> OWNER PHONE: : Ob �- ?D b 66114-S--- OWNER EMAIL: (,t tfv�ivt - _�..ad i yti I Uf a 11 b G� I <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: 0 OWNER 0 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 try 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> , ,� /i : PERMIT# <br /> ljimAtiv YIKe E got- <br /> Owner/AuthorizedgAgelit Signature Date( 7 (Revised 9/23/2016) <br />