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'ROW I.MW <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 /> 2215 Merrill Creek Parkway <br /> PROJECT ADDRESS <br /> Polo Properties LLC 9309 Olympic View Dr Edmonds WA 98020 (425) 261-1000 <br /> Owner Mail Address City State/Zip Phone <br /> Verizon Wireless M/S 3846, PO Box 3846 Spokane WA 99210 (866) 322-4547 <br /> Tenant Mail Address City State/Zip Phone <br /> Legacy Electrical 15580 SE For Mor Court Clackamas OR 97015 (503) 869-0365 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> LEGACE*9720H �Vl eCQU- SS <br /> State License Number(required) City of Ever tt Business License Number(required) <br /> Cellular Communications Equipment $4,500 <br /> Proposed Use of Building Contract Price of Work <br /> Pat Lyne (503) 869-0365,plyne@legacy-wireless.com <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of work to Be Done: Add (1) 80A Circuit for New Cellular Radio Equipment. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 $177.50 <br /> 1 hereby 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 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 <br /> performance of construction. That I am authorized by the owner of this property to perform the E I I C ._ •7 e <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and l ` l/ <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />