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ELECTRICAL PERMIT APPLICATION Imo►' y CITY OF EVERETT PERMIT SERVICES mitI3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: -•‘.-c::;-"1--) y-/,' 'r r; i J, BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: D'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: , r�'. .^,✓� f/ ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ • NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 1r-))0. ' ,r;r,. F 1(,,n ^;.a CONTACT INFORMATION OWNER NAME: % (yn :f..` r y TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET v) (C 'Iii Zirc e k; ,I,„cf, CITY C/�1��'}4S STATE ZIP C;;'' OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: G&S HEATING CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE cry EVERETT STATE WA zip 98201 CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@GSHEATING.COM CONTRACTOR LIC.#(REQUIRED): GSHTGSH93ORK CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 019685 PRIMARY CONTACT: 0 OWNER I2I CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-252-4402 DAWN WEIMER CONTACT EMAIL: DAWN@GSHEATING.COM AGREEMENT./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 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. That!am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# , �--- w E v (a —e95( Owner/Authorized Agent Signature Date (Revised 9/23/2016)