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To: E Page 2 of 3 2015-08-27 22:55:37(GMT) 18884000383 From: Deborah Shields <br /> ELECTRICAL PERMIT APPLICATION <br /> IO <br /> CITY OF EVERETT PERMIT IT SERVICE <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857--wvvw.everettwa.org <br /> 5108 Evergreen Way Ste 1A <br /> PROJECT ADDRESS <br /> Everett Smoke Shop 5108 Evergreen Way Ste 1A EVERETT 98203 206-354-8776 <br /> Owner Mail Address City State/Zip Phone <br /> Everett Smoke Shop 5108 Evergreen Way Ste 1A EVERETT WA 98203 206-354-8776 <br /> Tenant Mail Address City State/Zip Phone <br /> ADT LLC 11824 NORTHCREEK PKWY N#105 BOTHELL, WA 98011 206-774-9499 <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 400 <br /> Proposed Use of Building Contract Price of Work <br /> JENNIFER COVELLO 206-774-9499 JENNIFER@NWPERMIT.COM <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> 1 Control/ 2 devices <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Low volt security system <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ✓r 0 0 <br /> l hereby certify that I have read and examined this application and know the same to be true and <br /> I 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 nI��� �D <br /> performance of construction. That l am authorized by the owner of this property to perform the EK� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> °'g@aiycgrotl by bootee Covello 08/21/2015 <br /> Jennifer Covello'°"`°°`'°°°mer°°.aa°.°."anlnvaslF°,mK <br /> m[,AY.Onlail^�CnnNerC'}�nwPermll.c°m,C-Uia <br /> °oto:2016.0 8.06 12:+1:16-0700` <br /> Signature Date <br /> REVISED OS/06/201d <br />