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age: 2 of 2 04/22/2016 03:31 PM T0:1425257885? FROM: Kate Anderson PHONE #3 <br />294827E <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 />5416 S. 3rd Ave Everett WA 98203 <br />PROJECT ADDRESS <br />Brian Moore <br />Owner <br />Tenant <br />5416 S. 3rd Ave <br />Mail Address <br />Mail Address <br />Amped Electric & Mechanical LLC PO Box 868 <br />Electrical Contractor Mail Address <br />AMPEDEM907D4 <br />State License Number (required} <br />Single Famify Residence <br />Proposed Use of Building <br />Square Footage (If residentiai new construction, remodel or addition) <br />Number of devices (If low voltage} <br />Description of Work to Be Done: CIfCUItS fOf fUt'f1aC2 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Everett <br />C ity <br />City <br />Everett <br />City <br />WA, 98203 <br />State/Zip <br />State/Zip <br />WA/98206 <br />State/Zip <br />425-344-1579 <br />Phone <br />Phone <br />360-294-8276 <br />Phone <br />#048712 <br />City of Everett Business License Number (required) <br />300.00 <br />Contract Price of Work <br />Kate /360-294-8276/info@ampedelectricllc.com <br />Contact Person/Contact Number/Email <br />l he�eby certify that ! 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 wo�k wiil be completed <br />whether specified herein or nof. The granting of a permit does not presume to give authorify fo <br />violate or cancel the provisions of any other state or local law regulating constructron or the <br />performance of construction. That I am autho�ized by the owner of this property to perform fhe <br />work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />J�,,% l��vr.aa+� <br />Signature <br />REVISED OS�OG/2074 <br />4-22-2C�1 G <br />FE E <br />�'�5, o� <br />PERMIT# <br />E 11�0�' I�-�Z <br />