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I �P,e : 2 of 2 O1/ 13/2015 02 : 53 PM T0: 19252578857 FROM : AndreN T. Stipech <br /> PI{ONE H'L064915506 <br /> i— --- <br /> ELECTRICAL PERM�T APPLICATION <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8870 - FAX425-257-8d57—www.everettwa.org <br /> 2AU5 Broadway. Everett WA 96201 <br /> � PROJECT ADDRESS i <br /> � <br /> i <br /> Gnner MedAtlOress Gty SteleiZ�p Vhonc �� <br /> i <br /> Tenant 61ei1 Adaress Gty State2iD Phone <br /> Amped Eicunc 8 bledmn�wl LLC PO Box 868 Everetl WA199206 425-583•6414 � <br /> i <br /> I Eiectncal Contract0� hlad Atltlress CRy State2ip Phone <br /> I <br /> I AhqPLDCN�907Ua R048712 ' <br /> � Slate License Number(required) Cdy ot Everett Business License Number�required) <br /> I Smgic Famdy Rcs�denco <br /> E300.00 i <br /> I Nroposed Use ot Butlding Contratt Price ot Work ' <br /> � AndrewStipe[h1425�152�31141art peacm'=�gm�,l crn � <br /> Square Footage(If revdential new construc6on, remodel or addi6on) Gontacl Person/Contact NumbeirLmar � <br /> I <br /> � 2 arcuns �, <br /> I � <br /> � t�wnber of devices�1f low vouage) I <br /> add urcuits for elr.ctnc furnacc �� <br /> Dr;cripLon of Woik to Be Done . <br /> _ I <br /> � <br /> FCE --- ----- -- i i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 ��GJ (� <br /> 0 <br /> / I � <br /> I hereuy certAy thaf I havr read end eaammrd Ihrs appbcafron and know fhe same lo be frue and � __ J ' <br /> coneci All provisroris ol ia�vs and ord�nances goveminp lhrs type ol work�vdl6e completed ----- -- -- -- � <br /> �vhrfhc�specdred here�n or not. The granfmg ol a permd does not prnsume lo give aulhonty!o PERMIT# � I <br /> vmlate or cancel(he provrsrons o!any ofher slafe or local la�v regulatrng construt7ron or the � (�O I . _ . � <br /> pedomrance o!concfiucGon Thaf I am aufhonzed by fhe owner o!this propeRy to peAorm�he � O� , <br /> woik lor ivhrch applrcabon rs made and I comply wilh fhe Stale Cont�aclors La�v 18.27 RCIN and I <br /> 296 200 lM1'AC. <br /> } � L�3 2015 <br /> .nu�e (Qn.u�.wn <br /> :�i3nature Uaie <br /> ,.�.c;r���;.., .;r <br />