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To E Page � of 2 2015�01�12 '19�09.31 (GM� 'IB884000383 From� Deborah S�ieltls <br /> _ -- ._ <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857-wow�.everettwa.org <br /> cg�sa�-Dly <br /> 1 ('814 19th Ave SE � ��3 -�s <br /> PROJECT ADDRESS <br /> GRAiGERICKSONDDSMSDPLLC 10814 19th Ave SE EVERETT WA 98201 4Z5'�3�'4�3a <br /> Qvmer Mn�l AAAress Gty Siate:Lq Phnne <br /> Sky Ridge Peridontics 1511 26th St WA 98201 QZr337-1734 <br /> TCnent 6�ud Acld�ess Cdy Slate/Lp Phane <br /> ADT LLC >>�Z� NORTHCREEKPKWYNZ105 gpTHELL, WA 98011 �ZS-6t0-7569 <br /> Eiectrical Contraqor Mail A�aress G����y Sta�e�Lp Phone <br /> ADTLLL*881 DO 050955 <br /> State License Number(requiretl) Crty of C-verett Bus�ness License Numtier(requued) <br /> COMMERCIAL 400.00 <br /> Proposed Use of Bwlding Contract Pnce of`Nork <br /> JENNiFER COVcLL020F775�9a99 JENNI�ER@NYlP"cRldli.0061 <br /> Square Footage Qt resitlenual nev:consWction, remodel or addillon) Con;act Person:Contact Numhedf iail <br /> 1 CONTROL/ 12 DEVICES <br /> Number ot devices pf low voltage) <br /> oes�„�,,o„o„No,�,o Be oo�� Adding to existing Alarm system <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TA% CODE IS�106 I� Q b <br /> I heieby certdy that!have rea7 and exammetl thrs applicatron and know fhe same to be true and <br /> correct All provisions ol laws and ordrnances govem�ng th�s fype ol work�vill be completed <br /> �shethe�specified herein or not The granting ol a pe�mrt does not presurne to grve autbonty �o PERM IT# <br /> violate or cancel!he prov�sions ol any other state or local laiv regwat�ng cons�uction or the ^ � I �� I <br /> periormance ol consl�uc�ion. That I arn au(honzed by the owner o�thrs propert/ to per7orm !Be t � . /�� � <br /> work lor whiclr apphcat�on is matle and I canply with tl�e Stafe ConfraUors Law 78 27 RCW and �� <br /> 296 200 WAC <br /> °:.N:'`��,'."�.�''.�' 01 /12/2015 <br /> Jennifer Covello M°o...::,�°.°'� , d'°°" <br /> ,.�.�.a_...r�, <br /> OnG :1�5G11•1�I pl:!OtCa� <br /> Signature Date <br /> F'✓rj.pG°.lYr Ule <br />