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To: Page 2 of 3 2017-07-10 18:34:28(GMT) 18884000383 From: Northwest Permit Inc. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <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 ADDRESS:5119 15th Ave W PROPERTY TAX#00742000000700 'TOICr <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> owNERJerald Beal Phone/E-mail 425.268.8493 <br /> Address 5119 15th Ave W City/state/zip Everett WA 98203 <br /> APPLICANT: _Owner _Owner's Agent __Contractor 1 ;ontractor's Agent _Tenant(must provide a letter or consent from the ow er to do wort;;n we spa •) <br /> CONTRACTOR HOME DEPOT USA, INC State Lic. # HOMED**088RH City Bus.tic.;'# 57001 <br /> Address 2455 Paces Ferry Rd Atlanta 30339 Phone/Email 800-381-5699 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Dyanna Sconz orth st Perm! <br /> Phone/E-mail 360-945-278 y@nwDermit.corn <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR 14.069.9 <br /> Existing Use of Building HE SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: x Single Family Duplex Townhouse Multi-Family _ Commercial <br /> Type of project: New Addition Remodel J Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Replacing 25 squares of comp. No plywood unless found at time of install. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration Repair Type of Project: _New_Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units ; Toilet <br /> Forced air systems ; Bathtub <br /> Gas .i.in. I Lavatory (wash basin) <br /> Water heater Shower <br /> Gas fireplace p � Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer I Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> { Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM ! Other: <br /> Number of Heads Other: <br /> • <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp) <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That 1 em authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> Dyanna Sconzo-Digitally signed by Dyanna Sconzo, <br /> L/ J IIale:2017.07.10 112841-07'00' <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />