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To: E Page 1 of 2 2016-05-26 12:06:22 (GMT) 18884000383 From: Deborah Shields <br /> 10F17- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 { (E) everetteps©everettwa.gov { www.everettwa.gov/permits <br /> PROJECT SITE I FORMATIO .:{. . <br /> PROJECT ADDRESS:1402 SE EVERETT MALL WAY UNIT 181 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE SFR-DETACHED SFR-ATTACHED DUPLEXMULTI-FAMILY-#OF UNITS: ✓ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL. APPLICATION IINFORMATION <br /> CONTRACT PRICE OF WORK: $200 <br /> NUMBER OF DEVICES(if low voltage):11 <br /> FIRE ALARM? ❑YES / NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CCTV SYSTEM <br /> CONTACT INFORMATION <br /> OWNER NAME: COMPLETE ENTERTAINMENT EXCii TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1402 SE EVERETT MALL WAY UNIT 181 <br /> CITY EVERETT STATE WA ZIP 98208 <br /> OWNER PHONE:610-772-5110 OWNER EMAIL: <br /> CONTRACTOR NAME:ADT LLC <br /> CONTRACTOR ADDRESS: STREET 11824 NORTHCREEK PKWY N#105 <br /> CITYBOTHELL STATE WA ziP 98011 <br /> CONTRACTOR PHONE:206-774-9499 CONTRACTOR EMAIL:JENNIFER@NWPERMIT.COM <br /> CONTRACTOR LIC.#(REQUIRED):ADTLLL`881 DO CITY OF EVERETT BUSINESS LIC.#(REQUIRED)050955 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR / OTHER(Please Specify) JENNIFER COVELLO/AGENT <br /> CONTACT NAME: CONTACT PHONE:206-774-9499 <br /> JENNIFER COVELLO CONTACT EMAIL:JENNIFER@NWPERMIT.COM <br /> AGREEMENT.'T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 15. <br /> Digitally signed by Jennifer PERMIT# <br /> Jennifer Covello.`Date112016.05.1206:15:06 05/26/2016 Eg/405- 0/5 <br /> -07'00' <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br />