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ELECTRICAL PERMIT APPLICATION <br /> !**"11111 :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: S • <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: )Z1 SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: - ,\,l rill dt <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): r <br /> FIRE ALARM? ❑YES I NO <br /> ASSOCIATED BUILDING PERMIT# f applicable): <br /> DESCRIPTION OF WORK: is s€, ,1"t ' \Ma± (x; *— <br /> N. <br /> n'd am U�i(Y`lft a A=r "A <br /> CONTACT INFORMATION <br /> OWNER NAME: G„(�,'k >,/ j/1�111cr"—� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ♦''''t;'"5 • ��f � <br /> crrr � `„ kA c (4K1A77 STATE ZIP <br /> OWNER PHONE: Li(` .-�— I�j OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> circ 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 [[I 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> lr PERMIT# <br /> , �- E `$ c <br /> Owner/A,uthorized Agent Signature Date (Revised 9/23/2016) <br />