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� <br /> ELECTRICAL PERMIT APPL�CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FrV( 425-257-8857 —www.everettwa.org <br /> 4922 Forest Dr, Everett 98203 <br /> PROJECT ADDRESS <br /> Tina Loop 4922 Forest Dr Everett WA, 98203 (316)304-3145 <br /> Owner MailAddress Ciry SlatelZip Phone <br /> TenBnt Mail AdEress City State/Zip P�one <br /> Blue Flame Heating 8 A/C 7116 220th St SW#1 Mountlake Terrace WA, 98043 (425)771-7139 <br /> Electrical Contrador Mail Address City Statel2ip Phone <br /> BLUEPFH8fi70R $600 <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> Square Footage(If residential new construclion, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done. InStall new Circuit for l�at DumP• <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I �`O�� <br /> I he26y certily that I have read and examined this application and know fhe same to 6e frue and L J <br /> correct. All provisions ollaws and ordinances goveming this type o/work will be completed <br /> whether specified herein or not. The granting oI a permit does noI presume to give authority fo PERMIT# <br /> violafe or cancel fhe provisions ol any ofher sfate or local law regulafing consfrucfron or the E�� ( D - O 53 <br /> peAormance ol construction. Thaf 1 am aufhonzed by the owner ol this property to peAomr fhe <br /> woAc lor which applicafron is made and 1 comply with fhe Sfate Contracfors Law 18.17 RCW and <br /> 296.200 WAC. <br /> �.(L� ,e f .P,(�&P.� lb -7-1� <br /> Sign ure Date <br /> REVISEDYl�'13 <br />