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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 98201 <br />425-257-8810 - FAX425-257-8857—vnnM�.everetltva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PP/I <br />1510 SE EVERETT MALL WAY <br />PROJECTAODRESS <br />PERFECT SLIILES DENTIS7RY 1510 SE EVERETT NIALL WAY <br />Ovmer <br />Tenant <br />ADT LLC <br />Ir1ai� AtlCress <br />Mall Adtlress <br />Everett <br />Gt� <br />c�c� <br />11824NORTHCR6EKPKVJYN gOTHELL, <br />�lectriCal ConVa:tof Mall ACdress <br />ADTLLL�`881 DO <br />State L�cense Number <br />Commercial <br />?roposc: Use of Bwldina <br />Descnption o1 Work to Ee Dane� <br />o� <br />INTRUSION INSTALL-INSTALUNG A R[PEATER (One device) <br />ldOTE VVIRING IN NON-DWEL�I��1GS IS REC]UIRED TO <br />BE IN RACFWAYS, I/lC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WA, 98208 <br />StatelZia <br />SatrJZiD <br />WA 98011 <br />Slate2p <br />$200 <br />Cordract Pnce ol Work <br />a2ss�s22z2 <br />Fhone <br />Phone <br />206-774-9499 <br />Phcnc <br />jenn ifer@nwpermiLcom <br />Con,act Person (Plan P.eview) <br />1 hereby ceri!/y that I have reatl and examinetl thrs apphcation and kno�v fhe same to be tiue and <br />cdrect. AI! provisions ol/aws and ordmances governmg fh�s lype o(v: ork wil/ be compfeted <br />whether spenlied herem or nof. The granling ol a permrt does not presume to gme aufnerrty to <br />w�'ate or cance� fhe p�ov�srons ol any other sta(e or loca/ law regulanng cons6ucLon or the <br />pEvformance o/ consfrudron That I am authorized by tne ovmer ol th�s property fo perform fhe <br />work Ior whicA applica6on is made antl I comply �vRh (ne State ConLaclor5 La�v 7H27 RCW and <br />296.200 4VAC <br />Jennifer Burgess .��„ ,,,,�,�~ ,.� -�����° 05/24/2013 <br />Sgnature ate <br />rE� — <br />50•00 <br />EI�OS- ISa. <br />