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i <br /> �LECTRICAL PERMIT APPLICATI�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 a "�-� "�Z <br /> 425-257-8810 - FAX425-257-8857—wanr�.everettwa.org �zDZ _�N� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 11014 19th Ave SE Suite 4 & 5 <br /> PROJECT ADDRESS <br /> 24 Hour Fittness same as project address EVERETT, wa,sazoa <br /> Owner Mail Address Ciry Stalrlip Phone <br /> SAME AS SITE <br /> Tenant Mail Address Qty State/Zip Phone <br /> ADT 11824 NGRTHCREEK PKWY N gOTHELL, WA 98011 206-774-9499 <br /> F.lectrical Contrac[or Mail Address Clry State2ip Phone <br /> ADTSF_S103205 $13,000.00 <br /> State Ucense Number Contract Price of Work <br /> commercial jennifer@nwpermit.com <br /> Proposed Use of '�uilding Contact Person (Plan Review) <br /> Description of Work to Be Done: <br /> Replacement of the existing video recorder and the addition of one CCN �amera <br /> NOTE' WIRING IN NON-DWELLIf`1GS IS REQUIRED TO FEE <br /> �� IN RACEWAYS, IJIC OR AC CABi.E. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ) /'� n ` +J ' <br /> I hereb1�ceni(y thal I have read and exammetl ehis appfication entl know the same to be true and i�I Ol�a� I T'1' <br /> carecC. AU provis�ons o(laws and ordinances govermng fhis ty,oe o/work will6=completed <br /> whefher speci7red he�ein or not. The gran�ing ol a permrt does��ot presume to give authorrty to <br /> violate or cance/the provisions ol any other stafe or localla�v reyulatlng constructron or the <br /> perlermance of construd�on. That!am authorized by the o�vner o!this properfy to perlorm the <br /> wcrk lor vihich application is made and/compty witli the State Conuaciors Law 1827 RCW and <br /> 296.200 WAC. <br /> Jennifer Burgess . „ ,,,, . .r � ".'",,,' 02/24/2012 <br /> Sgnature ate <br /> I <br />