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To: Permit Departement Page 2 of 4 2016-06-17 '18:37:07 (GMT) 18884000383 From: Deborah Shields <br />� � <br />PERMIT APPLICATION <br />BUILDING/MECHANICAUP�UMBINGISlGNiSPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMiT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />siTE aooR�ss: �422 3rd Dr W <br />LEGAL for na�a construction: Short Platlsubdiv <br />ERGloria Johnson <br />7422 3rd Dr W <br />LiCANT: _ Owner _ Owner's Agent __ Contractor <br />rAx �r Q0834000001700 <br />No. (attach copy of long legal descriptfon) <br />Phone;E-mail (425) 265-0386 <br />c�ryiscaceiz�p Everett WA 98203 <br />Agent _ Tenant (must provide a letter at consent trom the awner to do worK in Uie space) <br />coNTRacroRThe Home Depot At Home Services State Lia # HOMED*"972RQ c�ty aus. uc. # C"� <br />Address3600 Lit1d Ave SW #150, Retlto�l 98057 Pho�e��mai�800-381-5699 <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />Naida Khan/Northwest Permit Inc. <br />PhoneiE-rnail 3�0-945-2787 naida@nwpermit.com <br />BUILDlNG PERMIT APPltCAT{ON CONTRACT PRfCE OP WORK $12�128•�8 <br />Existing Use of Building HERT SOURCE <br />Pt�oposed Use of Buiiditlg Gas_ Electric_ Other_ <br />Building type: �Singie Family _ duplex _Townhouse Multi-Family _ Commerciai <br />Type of project: New Addition __ Remodel � Repair _ T.I. Sign _Sprinkler _ Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the beck) : <br />Remove and replace 20.3 squares comp. roofing. Replace 6 squares plywood. <br />MECHANiCAL PERMiT APPLlCATtON <br />Type of Project: _New _Addn _Alteretion _Repair <br />Show Number (#J of fixtures <br />a A/C — air handlinq units <br />Forced air systems <br />_ i Gas piping <br />Water heater <br />'. Gas fireplace <br />Go4hes dryer <br />Ranqe hood <br />; Exhaust fan <br />Heat pump <br />i Unit heater <br />i <br />� g01�2T <br />� Refriqeration <br />s Woodstove <br />� Ducting <br />Other <br />SPRiNKLER / SUPPRESSiON SYSTEM <br />Numberof Heads <br />PLUMBiNG PERMtT APPLICATiON <br />of Project: _New _Addn _Alteration ,_ _Repair <br />Show Number (#) of fixiures <br />Toilet <br />i Bathtub <br />, LavatoN (wash 6asinl <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />Water heaier <br />Sink (servicelb� <br />Urinal <br />Drinking Founiain <br />Floor drain <br />Medical Gas <br />Other: <br />Other: <br />I hereby certrfy that I have read and ezamined this application and know the same to be true and correct. All provisions ot laws and ordinances governing this type of work wi{I be compl <br />with whether specified herein or not The granting of a permit dces not presume to give authority to vioiate or cancei the provision of any other state or local law regutating construction <br />i hat I am authonzed by the owner of this prop�ert� to perform the work for which application is made and 1 comply v�th the State Contractors Law 1827 RCW and 29f.200A WAC. <br />Naida Khan °� 'Y d �°b>���`Kr`° <br />DN�. c^��haid� Khar,, o�NorthLu.st Permit I�c.. o��.i, <br />ama.l=-:��i C?.. v.i�e:-mit rn, �US <br />Da�c, 20'��6.G6J7 `�:1:36:OG-u71iC� <br />Owner/Authorized Ageni Signature Date <br />(Revised 9/2014) <br />