3010 21ST ST 2023-06-16 - Laserfiche WebLink

MECHANICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT WASHINGTON SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plan to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits (Blue or Blipck Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET G % �/J / S 11 %� r � T PARCEL #: G it �✓` ! % D l 3 U J CITY L- L�€/C, % % STATE ;�, ZIP SUITEIUNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: TENANTIBUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: 14 ti f- /Ur. c. Tl! 4- J / OWNER MAILING ADDRESS. STREET 3 v 1 0 / cnY t•'� RE T T STATE zip U �• D � OWNER PHONE: t-/- I— `F v .T 6 ok 7 OWNER EMAIL' 1 /) % /I /L • C J /"i CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: M OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: r* I i1 /_ 0%C. CONTACT PHONE: xf J. `f 7 D CONTACT EMAIL: MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $ /I '' ASSOCIATED PERMIT # (if applicable): (Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) BUILDING TYPE: ®SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units; ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: %j��C� / / // t /(/�T r �% / jl.',; TA L I•- F C MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Count (Qty) List of Fixtures Fixture Count (Qty) List of Fixtures A/C Unit (attach plan with location of outdoor unit) O Gas Piping - List # of outlets in fixture count 0 Air Handling Unit ** 0 Gas Appliance ** G Boiler (most require back(low prevention) 0 Gas Fireplace, Insert, and/or Log (* for commercial bldgs) Commercial Refrigeration (Walk-in coolers, VRF, VRV, etc.) 0 Gas - Other (List Type): ** 0 Commercial Ventilation (corridors, stairwell, pressurization, etc.) Heat Pump (attach plan with location of outdoor unit) 5 Compressors/Generators (building permit may be required) tktk ( Heat Pump Ductless (attach plan with location of outdoor unit) 0 Clothes Dryer Exhaust Q Hydronic Piping Duct System (additions, alterations) J Unit heater (commercial use) U Exhaust Fan (residential or commercial use) Water Heater (gas or electric) 0 Exhaust Hood (residential over stove) J Wood/Pellet Stove or Insert (; Exhaust Hood Type 1*** Q Other (List Type): J Exhaust Hood Type II Other (List Type): Furnace (residential) is Other (List Type): * For commercial gas fireplaces, please attach plans and manufacturer's installation manual. sir k Under Description of Work, please include Type of Equipment, model Vs, ad detailed description of work, and the location of the equipment. Type I hood and Type II hoods shall be on a stand alone Mechanical Permit application and requires plan review. Please submit the required documents as *** described in the associated Checklists online at everettwa.gov/permits under the Checklists & Handouts tab. ACKNOWLEDGEMENT- I have reviewed this application and confirm the information contained nerein is true and correct. wont done pursuant to inis permit must comply wntr current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the Buirding Official before being authorized under any circumstance. I am the owner, or I am 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 RCW and 296.200A WAC. Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # M 23 0 t- - o ! 3 (Revised 412112022)