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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. M <br />PERMIT M <br />4806 Ocean Ave 00571700500100 <br />OQ014-037 <br />LE&LF LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITy21P PHONE <br />Mat DiMarco 4806 Ocean Ave Everett 98203 425-931-9275 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />INaida Khan 360-945-2787 <br />CONTRACTOR Home Depot At Home Services ADDRESS OTY21P PHONE <br />140 County Line Rd, #101 PACIFIC 800-381-5699 <br />CONTR. LICENSE HOMED**972RQ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />SFR <br />_Electric _ Gas —Other <br />$11573.00 <br />WORK DESCRIPTION <br />REMOVE AND REPLACE 27 SQUARES OF COMPOSITE ROOFING; NO PLYWOOD <br />REPLACEMENT <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink(service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_ <br />_ <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstwe <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerftify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a pernYt does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Digitally signed by Naida Khan <br />DN: cn=Naida Khan, o=Northwest <br />Signature of Owner/Contractor/Authorized Agent Naidato a n Permit Inc., ou, <br />email=naida@nwpermit.com, c=US <br />Date: 2012.04.2617:30:41-07'00' <br />