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To: E Page 2 of 3 2015-10-05 23:49:33 (GMT) 18884000383 From: Deborah Shields <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.arg <br /> I <br /> I <br /> I <br /> I <br /> j 11419 19TH AVE SE # 109-A <br /> PROJECT ADDRESS <br /> MILHAM FAMILY CHIROPRACTIC 11419 19TH AVE SE# 109-A EVERETT 98208 425-379-2556 <br /> Owner Mail Address City State/Zip Phone <br /> MILHAM FAMILY CHIROPRACTIC 11419 19TH AVE SE# 109-A EVERETT WA 98208425-379-2556 <br /> Tenant Mail Address City State/Zip Phone <br /> ADT LLC 11824 NORTHCREEK PKWY N#105 g OTH E LL, WA 98011 206-7 74-9499 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> ADTLLL*881 DO _0_50955 <br /> State License Plumber(required) City of Everett Business License Number(required) <br /> i <br /> Commercial 200 <br /> Proposed Use of Building Contract Price of Work <br /> JENNIFER COVELLO 206-774-9499 JENNIFER(gNWPERMIT.COM <br /> Square; Footage (If residential new construction, remodel or addition) Contact Verson/Contact Number/Email <br /> 1 Control/ 3 devices <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Low volt Security System <br /> I <br /> I <br /> i <br /> i <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1101 hereby certify that/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 Q �_ <br /> performance of construction, That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 98.27 RCW and <br /> 298.200 WAC. <br /> .D�gda Jy egneG op Jennaar Ccoclb <br /> Jennifer CoveIIOADN::n•JennicrCevoao.o•NoMa:cstPcrmW 10/05/2015 <br /> 'm<.ou.crosimK nnlcr��nvipermil.com,cmU5 <br /> Dam:20t,.'u 8 0G 12'+1;1 G 07'00' <br /> Signature Date <br /> I <br /> I <br /> I <br /> PEWS ED 00i06:201e <br />