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To: Page 4 of 5 2017-09-19 23:30:08 (GMT) 18884000383 From: Northwest Permit Inc. <br /> � � <br /> PERMIT APPLICATION <br /> BUI�DING/MECHANICAL/PLUMBlNG/SIGNISPRINKLER/DEMOLITION <br /> CETY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> s�rE aofl��ss:5012 23RD AVE W pROPER�nrrax#00644500001500 �"'� � <br /> LEGAt for ne�a�construction: Short Plat/subdivision _ _ Lot No. (attach copy of long legal description) <br /> owtvERKOSUKE YASUDA Pnone;�-mai��25-387-0216 <br /> Address5012 23RD AVE W c�cY;sc�te�z�pEverett WA 98203 <br /> APPLICANT: _Owner _Owner's Agent __Contractor ✓ oniractor's Agent _Tenant�must crovide a iet�erorcrn,sent trom me ov;ne�io no worK:r,inespace� <br /> coNTRACTORHOME DEPOT USA, INC State Lic. # HOMED""'08F3RH City Bus. Lic.# 5700� <br /> Address2455 Paces Ferry Rd Atlanta 3Q339 Phone;Eir�u800-381-5699 <br /> TENANT BLISINESS NAME CONTACT FOR PERMIT <br /> Dyanna Sconzo/Northwest Permit Inc. <br /> Phone/E-mail 360-945-2787 dy@nwpermit.com <br /> BUILD[NG PERM[T APPLiCAT[ON CONTRACT PRiCE OF WORK ���848.95 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: �Single Family _ Duplex_Townhouse ❑Multi-Family _ Commercia! <br /> T e of 3�o ect: New Addition Remodel � Re air 7.1. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provfded on the back): <br /> Replacing 22 squares of comp and 22 squares of decking Plywood <br /> MECHANICAL PERMIT APPLlCATION PLUMBING PERMIT APPLtCAT10N <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn __Alteration_Repair <br /> Show Number # of fixiures Show Number # of fixtures <br /> ! A/C—air handiin units ; Toilet <br /> Forced air s stems j 8athtub <br /> Gas i in ; Lavatory wash basin <br /> Water heater ; Shower <br /> Gas fire lace ; Kitchen sink 8 dis osai <br /> � Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> I Ran e hood ! Water heafer <br /> i Exhaust fan j Sink service/barhno /etc. <br /> i Heat um ; $ackflow reventer <br /> Unit heater Urinal <br /> ! Boiler Drinkin Fountain <br /> Refri erafion Floor drai� <br /> Woodsfove Grease trap <br /> � Ducting ; Roof drains <br /> � Other Medical Gas <br /> SPRiNKLER / SUPPRESSlQN SYSTEM ' other: <br /> Number of Heads Other: <br /> f fiereby ceitify fhat I have read and examined this application and know Ihe same to be true and correct.All provisions of laws and ordinances goverrnnfl this rype ot worY,wili be compl <br /> with whether specifietl herein or not The granting of a perntit dces not presume to give authuriry to violate or cancel the provision of any other siate or local law regutating consfiuction <br /> That 1 am authonzed by the owner of this property to pertorm the work for which apptication is maUe and f compty with the State Coniractors La�v 18,2T RCW and 2�i(i200A WAC. <br /> f'1"•a n n•d JCQ nZ� Digitally signed by Dyanna 5conzo <br /> �-�y Date 2017 09 19 16 25 50-07'00' <br /> OwnerlAuthorized Agent Signature Date <br /> (Revised 9/2014) <br />