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ELECTRICAL PERMIT APPLIC�4TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRFET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — vnr✓v�.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM <br />333 Ever�tt Mall Wa <br />PROJECTADDRESS <br />Fverelt Mall Way Shell 333 Everett Mall Way <br />Owner <br />Tenant <br />ADT LLC <br />Mai� Address <br />I,fail Atltlress <br />Everett <br />City <br />Gry <br />1182dNORTHCREEKPKWYN gOTHELL, <br />Electn[al Contractor Mad Address <br />ADTLLL�`881 DO <br />State License Number <br />Commarcial <br />>roposetl Use of Bwlding <br />Descnption of Work to Be Done� <br />Install low voltage CC7V system <br />I�IO1�E �NIRING II�I ��ION-GWEI_LI[�IGS IS F.EQUiRED TO <br />�3E IN RAC6WAYS, PAC OR AC CAQLE. <br />CITY OF [VERETT LOCAL SALES TAX COOE IS 3105 <br />�ry <br />WA, 98204 <br />Statel'ip <br />State/Z�p <br />WA 98011 <br />State/Zip <br />$4300.00 <br />Contrect Pnce of �Nork <br />2067780961 <br />Phonc <br />Pnone <br />206-774-9�99 <br />Phone <br />jennifer@nwperrnit.com <br />Contact Person (Plan Review) <br />I l;ereby certity lnat I have iead and examinetl this appDcaLon and know the same fo be true antl <br />caiect. All provisions ollaws and ortlmances gnveming lnrs type o! woik u�dl be cempleled <br />whether specdieU here�n or noe The grantmg ol a permrt does not resume to give aurnarty to <br />vrolate er cance/ the prov�sions ol any other state or localla�v reguPting constructron or the <br />pnlormance el constructron. That I am authon?ed by !he o�vner o/ fh�s property fo perfoim the <br />wak !or wnrcli applicatron is made and � cbmply wrth Ure State Convactors Law 18.2i RCW antl <br />296 200 t4iAC. <br />�ennifer Burgess , ,`�`�„ , , :°;� �~�"���� 04/12/2013 <br />Signanue Date <br />C(�j0 ��—p�T� <br />