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3ge: 2 of Z 09/26/2014 10 : 17 AM T0: 14252578857 FROM : Donna Barner PH <br /> E N2064915506 <br /> �r— -- -- — ---— - l <br /> ELECTRICAL PERMIT APPLICATION I <br /> , I <br /> CITY OF EVERETT PERMIT SERVICES j <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857—w�,vw.everetriva.org <br /> i <br /> ; 6002 Broadway � <br /> PROJ[CT ADDRESS � <br /> i <br /> Jerri Wheeler 6002 Broadway Everett W�982�3 425-754-6811 <br /> i OwnP.r Mail ACdres, City SWteR��p Phonc <br /> I <br /> I <br /> Tenant Mail Addmss C0y S;ate2ip Phonc <br /> AMPED Electric & <br /> i tilechanical, LLC P.O•Box 868 Everett WA/98206 (425) 583-6414 <br /> � ElgCtriC3I ContraCtof tdail ACAress Ciry Statcl2ip Phnne <br /> � <br /> � AMPEDEM907D4 048712 <br /> St3te license Numhet(�Equire0) Ci1y of Everett Business License Number(reduired) <br /> Single Family Residence <br /> Pr,posed Use of Building �,;nlracl Price uf Work <br /> iSquare Foot�ge Qf residential nmv construclion,remodel or addition) Conlacl PersonlConlacl NumbedEmail <br /> I _ <br /> I �umber ol Aevices Qf low voltac�e) <br /> � Description of Work lo Be Dono: ��SIB�� CIfCt11IS fOf dUC��BSS he2l pUfllp <br /> � <br /> � FEE I <br /> � O� <br /> iqTY OF EVERETT�LOCAL SALES TAX CO�E IS 3105 �O <br /> 1 hereby certi(y 1h�t I have read and e+xarnined Ihis app6catinn and knrnv the samo to be tmo and <br /> caroct. All provisiuns ol laws snd ordinances govenring fhis fypn ol work will bo completed <br /> whelhei spocifed heroin or noC T�e granuny o!a permi�dovs not prosumc lo give aulhorify to P[RMITk <br /> violafe or cancel the provrsions o!any other sfafe or�ocal la�v regulaling consWction or fhe ^��O �' I �� <br /> pe�formanco ol consliuction. Tiiat I om authonzod by!he owner o/this property fo perform fhe t <br /> work Ior which applicafion is madc and I comply�vifh fhe Slate Confrac(ors Law 18.27 RCW 3nJ <br /> 246.200 WAC. <br /> iGl� <br /> , 9 - �6 -� � <br /> Sign re Dalo <br /> i <br /> f.R'6COOP.:g1d�a �."_ ' <br />