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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857— vAwi.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />4132 Federal Ave Suite D <br />PROJECT ADDRESS <br />Forest Park Church <br />Owner Mail Address city <br />FnrPSt Park Church SAME AS SITE <br />Tenant <br />ADT <br />Mail Address <br />city <br />Stale/Zip <br />Phone <br />Forest Park Church <br />State/Zip <br />11824 NORTHCREEK PKWY N BOTHELL, WA 98011 <br />Electrical Contractor Mail Address <br />ADTSES103205 <br />State License Number <br />commercial <br />Proposed Use of Building <br />Description of Work to Be Done: <br />Install low voltage security system <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Phone <br />206-774-9499 <br />City Stale0p Phone <br />99.00 <br />Contract Price of Work <br />jennifer@nwpermit.com <br />Contact Person (Plan Review) <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whither specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />wcrk for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />yu,W`.Np-n4 bw. <br />Jennifer Burgess w;„ 'w ;;�"`'`w"""" 03/22/2012 <br />Signature Date <br />FEE <br />