1217 LOMBARD AVE B 2023-09-26 - Laserfiche WebLink

i• EVERETT WARRINnTON MECHANICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plan to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425.257,8810 j (E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET % / f �!-r> 1Prt %,F.rt ;� /�V PARCEL M CITY..�,� .._. STATE SUITE/UNIT #: FLOORM ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: ,y�y _. y'/t�je 7 i s! W. Z---._. OWNER MAILING ADDRESS: STREET j �' d t:� t-e CiTY �STATF /�' TIP OWNER PHONE: JOWNER EMAIL: /�?erg t `�-- � ,� �•'C CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE #(REQUIRED): iCITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE zP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CON IACT NAME: % CONTACT PHONE: ✓ jy~ jam/ &;'�. - CONTACT EMAIL: - MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $ ASSOCIATED PERMIT # (if applicable): (Valuation shall Include the prevalling 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: MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Count (Qty) List of Fixtures Fixture count Ply) List of Fixtures A/C Unit (attach plan with location of outdoor unit) Gas Piping - List # of outlets In fixture count Air Handling Unit Gas Appliance �tt11r Boller (most require backflow prevention) ** Gas Fireplace, Insert, and/or Log (* for commercial bldgs) Commercial Refrigeration (Walk-in coolers, VRF, VRV, etc.) Gas - Other (List Type): ** Commercial Ventilation (corridors, stairwell, pressurization, etc.) Heal Pump (attach plan with location of outdoor unit) CompressorsiGenerators (building permit maybe required) 11r11r Heat Pump Ductless (attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronle Piping Duct System (additions, alterations) Unit heater (commercial use) Exhaust Fan (residential or commercial use) Water Heater (gas or electric) Exhaust Hood (residential over stove) Wood/Pellet Stove or Insert Exhaust Hood Type 191rtlryF Other List Type): Exhaust Hood Type it ftirlr Other (List Type): Furnace (residential) Other (List Type): * For commercial gas fireplaces, please attach plans and manufacturer's installation manual, *sir Under Description of Work, please include Type of Equipment, model its, ad detailed description of work, and the location of the equipment. Type I hood and Type 11 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 lab. ACKNOWLEDGEMENT: l have reviewed this application and confirm the information contained herein is true and correct. work done pursuant to this permit must comply with 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 vMfing from the Building Offlclal before being authorized under any circumstance.! am the owner, or 1 am authorized by the owner of this property to perform the work for which application Is made, and 1 comply vritir the State Contractors Law 16.27 RC W and 296.200A WAC. Signature Date City of Everett Official Use Only PERMIT# A,�— 07-Ll (Revised 21612021) "( f