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To: E Page 1 of 2 2015-10-13 18:33:59 (GMT) 18884000383 From: Deborah Shields <br /> i <br /> i <br /> ELECTRICAL PERMIT 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 /> j 11108 EVERGREEN WAY STE B <br /> PROJECT ADDRESS <br /> OS H I MA SUSHI 11108 EVERGREEN WAY STE B EVERETT 98204 425-356-9999 <br /> Owner Mail Address City State/Zip Phone <br /> OS H I MA SUSHI 11108 EVERGREEN WAY STE B EVERETT WA 98204425-356-9999 <br /> Tenant Mail Address City State/Zip Phone <br /> ADT LLC 11824 NORTHCREEK PKWY N#105 BOTH E LL, WA 98011 206-774-9499 <br /> Electrical Contractor Mail Address City State/Zip 'hone <br /> ADTLLL*881 DO 050955 - - <br /> State License Number(required) City of Everett Business License Number(required) <br /> Commercial 200 <br /> Proposed Use of Building Contract Price of Work <br /> i <br /> JENNIFER COVELLO 206-774-9499 JENNIFER(a_NWPERMiT.COM <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> 1 Control/ 3 devices <br /> Number of devices(If low voltage) <br /> i <br /> LOW VOLT SECURITY SYSTEM <br /> I <br /> Description of Work to Be Done: <br /> i <br /> FEE 1CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 47I <br /> I <br /> /hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed -- j <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 t am authorized by the owner of this property to perform the E 10,b2 <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and ��,/// <br /> 296.200 WAC. <br /> O'ipnn:ysgnceepJennR:rCevcib <br /> Jennifer Covello'DDInc,nn.un:.•0aJ1�5,-y,6r_0r0n�12.'n11,:.1,.-0N7o10�0,' <br /> 10/15!2015 i <br /> Signature Date <br /> L <br /> .REVISED ON06 2n» <br />