4310 COLBY AVE WESTERN WASHINGTON MEDICAL GROUP 2019-03-14

ELECTRICAL PERMIT APPLICATION -; CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 4310 COLBY AVE., STE 202, EVERETT, WA 98203 BUILDING AREA(if residential, new construction, remodel,or addition)REMODEL SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: VI COMMERCIAL USE OF BUILDING: Colby Medical v CONTRACT PRICE OF WORK: $ 200 NUMBER OF DEVICES (if low voltage): 1 FIRE ALARM? 0 YES El NO ASSOCIATED BUILDING PERMIT#(if applicable): N/A DESCRIPTION OF WORK: INSTALLATION OF ONE LOW VOLTAGE DEVICE + %iii n OWNER NAME: PETERSEN AND HILDAHL LLC TENANT NAME(If Commercial): PE ES:ANS f1EDA-Fr OWNER MAILING ADDRESS: STREET 2105 112TH AVE NE STE 102, U1j1fl uA e` cin, BELLEVUE, STATE WA ZIP 98004 �`" OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: PERFORMANCE MECHANICAL GROUP CONTRACTOR ADDRESS: STREET 1012 CENTERAL AVE S CITY KENT STATE WAZIP 98032 CONTRACTOR PHONE: (425)251-0356 (CONTRACTOR EMAIL: ERIC.O@PMGHVAC CONTRACTOR LIC.#(REQUIRED): PERFOHA005BS _ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 57268 • PRIMARY CONTACT: ❑OWNER VI CONTRACTOR 0 OTHER(Please Specify) vv.. CONTACT NAME: CONTACT PHONE: (425)251-0356 ERIC O'KEEFE CONTACT EMAIL: ERIC.O@PMGHVAC AGREEMENT:I hereby 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 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 local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 6v---"°e— - - 10/15/2018 E 1 $( 0 — 1(0 Owner/Authorized Agent Signature Date (Revised 9/23/2016)