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To: E Page 2 of 3 2015-06-16 16:50:38(GMT) 18884000383 From: Deborah Shields <br /> ELECTRICAL E IT 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 /> I ' <br /> 607 SE Everett Mall Way Ste A <br /> PROJECT ADDRESS <br /> Evergreen Food Mart 607 SE Everett Mall Way Ste A EVERETT WA 98203 909-518-6841 <br /> Owner Mail Address City State/Zip Phone <br /> Evergreen Food Mart 607 SE Everett Mall Way Ste A EVERETT WA 98203 909-518-6841 <br /> Tenant Mail Address City State/Zip Phone <br /> ADT LLC 11824 NORTHCREEK PKWY N#105 BOTHELL, WA 98011206.774.9499 <br /> Electrical Contractor Mail Address _� .,. City State/Zip Phone <br /> ADTLLL*881 DO 050955 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Commercial 381 .00 <br /> Proposed Use of Building Contract Price of Work <br /> JENNIFER COVELLO 206-774-9499 JENNIFER@NWPERMIT.COM <br /> Square Footage Of residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> 1 Control/5 devices <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Low volt security install <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that i have read and examined this application and know the same to be true and '�J <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 1 am authorized by the owner of this property to perform the E b (%(0- ®D 5 <br /> work for which application is made and I comply with the State Contractors Law 18.27 ROW and <br /> I 296.200 WAC. <br /> tanod°„Cont°r °. 06/16/2015 <br /> Jennifer Covello°"'°°''°°°t°�`°�°��°�"°nr�,°=�r°r°,� <br /> inc,.°u,ema hy:nnter�,nwpermil.cn m,c^US <br /> 00t0:2076.06.02 73:29:20 <br /> Signature Date <br /> REVISED 011/06,20Id <br />