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age : 2 of 2 12/10/2015 03 : 34 PM TO : 14252578857•FROM : Kate Anderson P <br /> NE 443606914517 <br /> • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 1006 Harborview Lane, Everett WA 98203 <br /> PROJECT ADDRESS <br /> Stan Niegeman 1006 Harborview Lane Everett WA 98203 425-259-4969 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Amped Electric& Mechanical LLC PO Box 868 Everett WA/98206 425-583-6414 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> AMPEDEM907D4 #048712 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Single Family Residence $300.00 <br /> Proposed Use of Building Contract Price of Work <br /> Andrew Stipech/360-691-4517 kate@ampedelectricllc.ccm <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> add two circuits for furnace <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and (� <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the I I <br /> performance of construction. That I am authorized by the owner of this property to perform the 061L, <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Xi,&Q Ur,aeraon 12-10-2015 <br /> Signature Date <br /> REVISED 08'0612014 <br />