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To. E Page 5 of 5 2016-05-19 21.15:57 (GMT) 18884000383 From: Deborah Shields <br /> 4Err ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROD SIVE lNFORMA #ON <br /> PROJECT ADDRESS:715 100TH ST SE STE Cl <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE SFR-DETACHED SFR-ATTACHED DUPLEXMULTI-FAMILY-#OF UNITS: ✓ COMMERCIAL <br /> USE OF BUILDING:COMMERCIAL <br /> ELECTRiCA . >�#PPLJCATION INF€RMATION:' <br /> CONTRACT PRICE OF WORK: $600 <br /> NUMBER OF DEVICES(if low voltage):4 <br /> FIRE ALARM? ❑YES / NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: LOW VOLT SECURITY SYSTEM <br /> CONTACT INFORMATION <br /> OWNER NAME: GOULD SOUTHERN TENANT NAME(If Commercial):GOULD SOUTHERN <br /> OWNER MAILING ADDRESS: STREET715 100TH ST SE STE Cl <br /> CITY EVERETT STATE WA Zllr 98203 <br /> OWNER PHONE:425-493-9292 OWNER EMAIL: <br /> CONTRACTOR NAME:ADT LLC <br /> CONTRACTOR ADDRESS: STREET 11824 NORTHCREEK PKWY N #105 <br /> CITYBOTHELL STATE WA ZIP 98011 <br /> CONTRACTOR PHONE:206-774-9499 CONTRACTOR EMAIL:JENNIFER@NWPERMIT.COM <br /> CONTRACTOR LIC.#(REQUIRED):ADTLLL*881 DO CITY OF EVERETT BUSINESS LIC.#(REQUIRED)05O9555 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ✓ OTHER(Please Specify) JENNIFER COVELLO/AGENT <br /> CONTACT NAME: CONTACT PHONE:206-774-9499 <br /> JENNIFER COVELLO CONTACT EMAIL:JENNIFER@NWPERMIT.COM <br /> AGREEMENT:Thereby 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 <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> X15 , 6° <br /> �p•F}�b,�iy a(,�t�Srr�ly Tyxt���'��7"" KyF' c1 <br /> Digitally signed by Jerv}ifer Covello PERMIT# <br /> DN:cn:=Jennifer <br /> },� � 1,'� ,i,��`.r� �ws• e ail jean feranw erm <br /> 5/19/2016 it com,c=US ,1��/n-�J <br /> Date:LU1U.U3.151U:ZU:Ud-UTUU' EV/ ( ''D f I <br /> Owner/Authorized Agent Signature Date Date (Revised 10/12/2015) <br />