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age: 2 of 2 <br />�E #3606914517 <br />10/13/2015 08:42 AM T0:14252578857 FROM: Kate Anderson <br />ELECTRICAL PERMIT APPLICATION <br />CfTY OF EVERETT PERMtT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />4612 Seahurst Ave, Everetf WA 98203 <br />PROJECT ADDRESS <br />Don Carter <br />Owner <br />Tenant <br />4612 Seahurst Ave <br />Mail Address <br />Mail Address <br />Amped Electric & Mechanical LLC PO Box 868 <br />Electrical Contractor Mail Address <br />AMPEDEM907D4 <br />State L€cense Number (required) <br />Single Family Residence <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done <br />circuits for#�tr+�ee <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Everett <br />City <br />City <br />Everett <br />City <br />WA 98203 425-258-3538 <br />State/Zip Phone <br />State/Zip <br />WA/98206 <br />State/Zip <br />Phone <br />425-583-6414 <br />Phone <br />#048712 <br />City of Everett Business License Number (required) <br />300.OQ <br />Contract Price of Work <br />Kate /360-691-4517/info@ampedelectricllc.com <br />Contact Person/Contact Number/Email <br />! hereby certify that l have read and examined this application and know the same to be true and <br />correct. AlI provisions of laws and ordinances gove�ning this type of work will be complefed <br />whethe� specified he�ein or not. The granfing of a permit does nof presume to give authority to <br />vio/ate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That / am authorized by the owner of this property to peiform the <br />work for which application is made and I comply with the State Contractors Law ?8.27 RCW and <br />296.200 WAC. <br />�t� �.la�a�L 10-1 �-2015 <br />Signature Date <br />HEVISED O8i(k7l2U74 <br />�l�ti�� [N � I� Gki <br />P <br />