1015 100TH ST SW 2024-08-06 - Laserfiche WebLink

4r-Sr' MECHANICAL PERMIT APPLICA PION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ( js +-� J P S1' PARCEL#: 6(0.566 7 0/ t/en too /�y CITY t�0 fit-C.-f STATE its4 ZIP 7/3 ()/ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: gi,,4.5-1-44/4.1. t S '-0.1 eicc1,s Iyr tC'11dvt OWNER MAILING ADDRESS: STREET PO ed JZ Y3 CITY May)/SYrti I to STATE LA)14- ZIP q 7d OWNER PHONE: 7 Z ^ ex., (S-`r,'/ OWNER EMAIL:#0,44*rot_6, f dc+-• 4o.z,.c t c ii1 CONTRACTOR COMPANY NAME: ,j�;,t,1d.4i/d ,5{-8rvN Cbtti54-1-44.0 WA STATE CONTRACTOR LICENSE#(REQUIRED): 54-h((,9(6,CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 573?CO CONTRACTOR ADDRESS: STREET pa 13c'v /Z'/3 CITY ajar'St/r`t/C STATE 1,04- ZIP ��/Q CONTRACTOR PHONE: i7 $, - (p,j 1 CONTRACTOR EMAIL: t) �1()$ )6-t, ,i f ttie`i e i Cry. PRIMARY CONTACT: 'S OWNER ❑CONTRACTOR ❑OTHER(Please Specify) ` CONTACT NAME: /CONTACT PHONE: Z 5 �76 - 5-57 Pe,„I 6 ,5y&Y6. CONTACT EMAIL: '(.SlfsuAtCuoIvo", 131v'i,..14.'1044.. 9t1'1rd,CCU MECHANICAL PERMIT INFORMATION VALUATION OF WORK:$ 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: t2FSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: (� COW S1(-Wt." Pk ) i- MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QtY) (QtY) NC Unit(attach plan with location of outdoor unit) } Gas Piping-List#of outlets in fixture count Air Handling Unit** Gas Appliance** Boiler(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.) Heat Pump(attach plan with location of outdoor unit) Compressors/Generators(building permit may be required)** Heat Pump Ductless(attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronic Piping Duct System(additions,alterations) Unit heater(commercial use) 1 1 Exhaust Fan(residential or commercial use) / Water Heater(gas or electric) / Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert Exhaust Hood Type I*** Other(List Type): Exhaust Hood Type II*** Other(List Type): Furnace(residential) Other(List Type): * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. ** Under Description of Work,please include Type of Equipment,model#'s,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 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 writing from the Building 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. City of Everett Official Use Only ? c ` PERMIT# M l Z .JCS Owner/AuthorizedAgent Signature Date (Revised 2/8/2021)