1615 SE EVERETT MALL WAY 2019-01-23

To: E Page 2 of 2 2016-10-07 13:46:53 (GMT) 18884000383 From: Deborah Shields • k*rr 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 PROJEC'i(T $ITE INFORMATIOI , PROJECT ADDRESS:1615 SE EVERETT MALL WAY 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: $500 NUMBER OF DEVICES (if low voltage):1 CONTROL, 3 DEVICES FIRE ALARM? 0 YES / NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: LOW VOLT SECURITY SYSTEM GOI41;40 I' INFORMAT14i4 .. OWNER NAME: CYPRESS LAWN MEMORIAL TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1615 SE EVERETT MALL WAY CITY EVERETT STATE WA ZIP 98208 OWNER PHONE:425-353-7141 OWNER EMAIL: CONTRACTOR NAME:ADT LLC CONTRACTOR ADDRESS: STREET 11824 NORTHCREEK PKWY N #105 C,TYBOTHELL STATE WA Z,P 98011 CONTRACTOR PHONE:206-774-9499 CONTRACTOR EMAIL:JENNIFER@N WPERM IT.CO M CONTRACTOR LIC.#(REQUIRED):ADTLLL'881 DO CITY OF EVERETT BUSINESS LIC.#(REQUIRED)050955 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 l 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 slate 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 Stale Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE Digitally signed by Jennifer PER IT# Jennifer Covello Date:112016.05.2217:12:03 10/06/2016 E l c D_ S -07'00' Owner(Authorized Agent Signature Date (Revised 10/12/2015)