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To: E Page 2 of 2 2016-07-25 13:16:31 (GMT) 18884000383 From: Deborah Shields <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.govlpermits <br /> PROJECT SIT NFt RMATI>�N,.: . . <br /> PROJECT ADDRESS:3813 RUCKER AVE <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE SFR-DETACHED SFR-ATTACHED DUPLEX MULTI-FAMILY-#OF UNITS: ✓ COMMERCIAL <br /> USE OF BUILDING: <br /> ELEGTRICAI. ARPLs]CATION INFORMAtION' <br /> CONTRACT PRICE OF WORK: $450 <br /> NUMBER OF DEVICES(if low voltage):4 <br /> FIRE ALARM? 0 YES ✓ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CCTV SYSTEM <br /> C4NTAC7 #NfORMATI4M <br /> OWNER NAME: PICK ME UP TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3813 RUCKER AVE <br /> CITY EVERETT STATE WA ZIP 98201 <br /> OWNER PHONE:425-773-4802 OWNER EMAIL: <br /> CONTRACTOR NAME:ADT LLC <br /> CONTRACTOR ADDRESS: STREET 11824 NORTHCREEK PKWY N #105 <br /> CITY BOTHELL 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)055O9555 <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 slate 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 /> Digitally signed by Jennifer PERMIT# <br /> Jennifer Covello COVe"° 07/21 /2016 <br /> Date:2016.05.22 17:12:03 E 1)1 ton-n I b-07'00' C V v <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />