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To: E Page 2 of 3 2015-03-30 15:59:25 (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 /> 10115 Holly Dr- Mech Shop <br /> PROJECT ADDRESS <br /> Covington Farms 10115 Holly Dr EVERETT WA 98204 425-348-6500 <br /> Owner Mail Address City StateiZip Phone <br /> Covington Farms 10115 Holly Dr EVERETT 98204 425-348-6500 <br /> Tenant Mail Address City StateiZip Phone <br /> ADT LLC 11824 NORTHCREEK PKWY N#105 g OTH E LL, WA 98011 2067749499 <br /> Electrical Contractor Mail Address city StateiZip Phone <br /> ADTLLL*881 DO 050955 <br /> State License Number(required) City of Everett Business License Number(required) <br /> COMMERCIAL 428.00 <br /> Proposed Use of Building Contract Price of Work <br /> JENNIFER COVELLO206-774-9499 JENNIFER@NWPERMIT.COM <br /> Square Footage(If 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 system install-Mech Shop (Not Duplicate) <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 4 ,�•00 <br /> 1 hereby certify that l 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 <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 l am authorized by the owner of this property to perform the <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> D,1111h0,Sig n9UbyJ,,,,ila«o.e1b 03/27/2015 <br /> Jennifer Covello"ON: J-Iter-Ib.-a,m-tP_�d <br /> D,A.:2015,03 23 14:42'08.07'00' <br /> Signature Date <br /> R17V ISEG 00,10 6 20 M <br />