607 SE EVERETT MALL WAY A EVERGREEN FOOD MART 2017-02-27

To: E Page 3 of 4 2016-12-14 15:22:45 (GMT) 18884000383 From: Deborah Shields s , *77' ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMA'TI+©AI:; PROJECT ADDRESS:607 SE EVERETT MALL WAY STE A BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE SFR-DETACHED SFR-ATTACHED DUPLEX MULTI-FAMILY-#OF UNITS: ✓ COMMERCIAL USE OF BUILDING: • ELECTRICAL APPLICATION INFORMATION', CONTRACT PRICE OF WORK: $1500 NUMBER OF DEVICES(if low voltage):1 control and 5 devices FIRE ALARM? ❑YES / NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CCTV SYSTEM (T-COMM) CONTpGT iNFORMATI4N . OWNER NAME: EVERGREEN FOOD MART TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET607 SE EVERETT MALL WAY STE A CITY EVERETT STATE WA ZLP 98208 OWNER PHONE:425-374-2938 OWNER EMAIL: CONTRACTOR NAME:ADT LLC CONTRACTOR ADDRESS: STREET 11824 NORTHCREEK PKWY N #105 CITYBOTHELL STATE WA zip 98011 CONTRACTOR PHONE:206-774-9499 CONTRACTOR EMAIL:JENNIFER@NWPERMIT.COM CONTRACTOR LIC.#(REQUIRED):ADTLLL`881 DO CITY OF EVERETT BUSINESS LIC.#(REQUIRED)0509rJ55 • PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ✓ OTHER(Please Specify) JENNIFER COVELLO/AGENT CONTACT NAME: CONTACT PHONE:206-774-9499 JENNIFER COVELLO CONTACT EMAIL:JENNIFER©NWPERMIT.COM 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 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 state or 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE Digitally signed by Jennifer PERMIT# Jennifer Covello Date:1I2016.05.1206:15:06 12/13/2016 E kL(2 - �� g 07'00' Owner/Authorized Agent Signature Date (Revised 10/12/2015)