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09-05-'10 12:49 FROM-nw permit 13609952091 T-137 P002/D02 F-321 <br /> � i <br /> � <br /> � PERMIT APPLICATION <br /> CITY OF EVERET'T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-3810— FAX 425-257-8857—wwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—�` /�/ <br /> SITE ADDRESS PARCEL iAX I,D.p ' PERMIT tl � <br /> 5005 23RD AVE W 006A4500002100 � � —�� <br /> LEGAL LOT NO. BLOCK TRAC7 <br /> OESC <br /> OWNEft qUDRESS CITYIZ�P PHONE <br /> JOHN CHRISTOFFERSON 5005 23RD AVE W Everefl 9e203 425 360-638-2646 <br /> 7ENANTN.4ME CON7qCTFORPERMIi PHONE <br /> INaida Khan 360-945-2787 <br /> CONTRACTOR W�SCO ADDRESS CITY121P PHONE <br /> C 28Q�J Thorndyke SEATTLE 800-398-4663 <br /> CONTR.LICENSE M WA[.H�CS97��B <br /> J <br /> USE OF FiUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> _ SFR _,eien,;� �Gas_Other I $5366.00 <br /> WORK DESCRIP710N <br /> REPLACE 100K BTU GAS FURNACE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. NPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airhandlingunils <br /> Bathtub � Forced air systems <br /> _ Lavaloy(w2sh busin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal Gas 6replaca <br /> _ �ishwasher Gasrange <br /> _ Clahes washer Clolhes dryer <br /> _ Laundry lray Range hood <br /> _ Sink(service/badmop/etc.) _ Exhaust fan <br /> _ 9a�kflow preventer Heat pump <br /> _ Urinal Unil healer <br /> Drinking Fountai� 8oiler <br /> _ Floordrain Refrigaration <br /> _ Grease trap Nloodstove <br /> _ Roof drains Other <br /> Olher -- <br /> CI7V OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify Ih2t I have r�atl and examined this application and know the same lo be Uue and cor�ed. Ail provisions of laws and <br /> ortlinaras governing this rype ol werk wiu be complied with whethar snecified herein or not, The granting af a permit does nol presume <br /> to give authoriry to vioiale or carcel the provisien o�any other state or local law regWating constmction or the pedormance of <br /> consiruction That I am authoriz by the owner of this property to pertor the ork tor which appiication is made and I compiy with the <br /> State Contractors L� w 18�27 R n 2�J62C0 WAG. <br /> � ���v �-��- S (c� <br /> Signawre o OwneuCon cto/Authonzed/{qent Dat <br />