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ELEGTRICAL PERMtT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �V�RETT, WA 98201 <br /> {P} 425-257-8810 � FAX 425-257-8857 � {E)evere#teps@everettwa.gov � www.everettwa.gouipermits <br /> ; .... <br /> ... <br /> ; . , PROJECT;$lTE INFORMAT10�i ' <br /> PROJEC'F ADDRESS: 3125 COLBY AVE <br /> BUILDiNG AR�A(if residential, new construction,remodel,or addition) SF <br /> SUILDING TYPE: C� SFR-b�TACHED ❑SFR-ATTACHED � DUPLEX � MULTI-FAMILY-#O�UN[TS: � COMMERCIAL <br /> USE OF 8UILDING: M�C�ICaI <br /> , , <br /> ' °:.:::-.:;::::;.::�LEC.TRNC%kL'�PPlICATIf�(�I:INFORMATION: <br /> CONTRACT PRICE OF WORK:$ 1300, <br /> NUMBER OF DEVIC�S if low voltage : � <br /> FlRE ALARM? ❑YES m NC! <br /> ASSOCIATED BUILQiNG PERMfT# if ap licable : M1710-084 <br /> DESCRIP71oN OF WORK: INSTALL NEW THERMOSTAT FOR NEW ROOFTOP AC UNIT. <br /> _. >.:..... ....::: ::::;:;::.:::;:;>::;.:;-::; ';::::::;:: .;:.:<;:,::-,:;:: >::::; ::::;::::: <br /> ; ' .:::, '.::.:'. C�NTACT'INFCRMATION;::° :. <br /> OWNER NAME: FIRST E3APTIST CHURCT QF EVT TENANT NAME{[f Commercial): CULBY PROFESSiONAL CENTER <br /> OWNER MAILING A�DRESS; ST���T ���9 RUCKER AVE STE 100 <br /> �,T,. EVERETT STATE WA z� 98201 <br /> OWNER PHONE: OWNER EMA1L: <br /> coNT�ncxo�Nam�: PSR MECHANICAL <br /> coNrRacraR A��Ress: STR�ET 3132 NE 133RD ST <br /> crn� SEA7TLE srAr� WA z�P 98125 <br /> CONTRACTOR PHONE: 2O6-3fi7-2500 CONI7'FtAC70R EMAIL: d8n12l.k1111 f��SPt71eCIlaC11CaI.CO!'Tl <br /> CONTttACTOR LIC.#�R�Qui��n>: PSRHVMS924JT CITY OF EVERETT BUSINESS LiC.#(REQUIRECs}: ��$�� <br /> PRIMARY CONTACT: 0 pWNER �CONTRACTOR ❑OTHER{Please Specify} <br /> CONTACT NAME: CONTACT PHONE: 2Q6-67B-9�4$ <br /> Da�tl@I KIt11 CONTACT EMAiL: daniel.kim@psrmechanical.com <br /> AGREEMENT.•!hereby certify that J have read and examined this applfcation and know the same to be true and carrect. A!1 provisions of laws and ordinances goveming this type <br /> of work wil!be complefed whether specified herein or not. The grantfng of a pemrit does not presume to give authorify to violafe or cance/!he provisians of any other stafe or <br /> local law regulafing construction or the pe�formance of consfrucGon. That!am authorized by tha owner of fhis properly to perform the work for which application!s made and! <br /> compJy with the Stafe Contractors Law 18.27 FtCW and 286.200 WAC. <br /> City of Everett Officia!Use ONy <br /> �,,.. PERMI7# <br /> --�'---..�.. I /� � 1 �s E t�� � -0-� <br /> nerlA h rized Agent S[goature Date (Revised 9/23/2016} <br />