9635 18TH AVE W 2019-06-05 - Laserfiche WebLink

4177- ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 9635 18th Ave W BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED m SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: residence ELECTRICAL APPLICATIMATION CONTRACT PRICE OF WORK: $ 500 NUMBER OF DEVICES (if low voltage): na FIRE ALARM? ❑YES ® NO ASSOCIATED BUILDING PERMIT#(if applicable): na DESCRIPTION OF WORK: Add circuit for FAU CONTACT INFORMATION OWNER NAME: Jim Klein TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 9635 18th Ave w cin Everett STATE WA ZIP 98204 OWNER PHONE: 425-876-0126 OWNER EMAIL: CONTRACTOR NAME: Amped Electric & Mechanical LLC CONTRACTOR ADDRESS: STREET PO BOX 868 CITY Everett STATE WA ZIP 98206 CONTRACTOR PHONE: 360-294-8276 CONTRACTOR EMAIL: Info@ampedelectricllc.com CONTRACTOR LIC.#(REQUIRED): AMPEDEM9O7D4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 048712 PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206 724 1 188 Mike Walker CONTACT EMAIL: MikeW@ampedelectricllc.com AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 ROW and 296.200 WAC. City of Everett Official Use Only PERMIT# Gc/a1A.im. 1 2/6/1 7 E Owner/Authorized Agent Signature Date (Revised 9/23/2016)