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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 5'8201 <br />425-257-8810 - FAX425-257-8857—vvdw.ovE�rettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO : PM <br />41 zo <br />41.34-Pederal Ave <br />PROJECT ADDRESS <br />Forest Park School same as Project Address <br />4252101909 <br />Owner Mail Address <br />City <br />State/Zip Phone <br />Forest Park School SAME AS SITE <br />4252101909 <br />Tenant Mail Address <br />City <br />Statelzip Phone <br />ADT 11824 NORTHCREEK PKWY N <br />BOTHELL, <br />WA 98011 206-774-9499 <br />Electrical Contractor Mal Address <br />city <br />State/Zip Phone <br />ADTSES103205 <br />99.00 <br />State License Number <br />Contract Price of Work <br />jennifer@nwpermit.com <br />commercial <br />Proposed Use of Building <br />Contact Person (Plan Review) <br />Description of Work to Be Done. <br />replace existing low voltage security system panel & keypad, connect to existing devices <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. �O � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceRi(y that I have read and exam/ned this application and know il:e same to be true and I2O2 _ I ZS <br />carecL Alf provisions o/laws and ordinances governing this type ofwork will be completed f <br />whether specdled herein or not. The granting of a permit does not ppresume to give authority to ,1 <br />violater cancel the provisions o! any other state a local law regulaSng Cons <br />or the ' <br />performance olconsVud/on, Thet I am authorized, by the owner o! this property to perform the <br />wak for which applfcaton is made and I comply tvrth the State Contractors Law 18.27 RCW and <br />2u6.200 WAC. <br />W..4.WNp,rv.bi.nW. <br />Jennifer Burgess ;;;;',,;;,";��'°'�03/21/2012 <br />Signature ate <br />