1019 100TH ST SW 2024-08-06 - Laserfiche WebLink

E MECHANICAL PERMIT APPLICATION 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 1017 l 620 ' 54- 3 Ij) PARCEL#: Z @ 0q,3(0 30%yo0 CITY eT,e_ STATE /OR ZIP 9'✓ ('% SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: ,(st:ti54-a4 LL—S/cam.. Loy" is*r. -f-}0✓i OWNER MAILING ADDRESS: STREET Po �s' ,ay 3 Y` CITY OA Ct.(��y f i/1 ik STATE b,l AZIP f Z /V1 OWNER PHONE: OWNER EMAIL:1?u)7 fG.vv 4eL A—(talc{-JLt.L fccy sL twi t`/,cotes CONTRACTOR COMPANY NAME: 6cyS¢-p✓6( ec, 710,, - Cot'.-3 <,.EfroL" WA STATE CONTRACTOR LICENSE#(REQUIRED): l5,51-46C 92 f 1Gr CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 335 CONTRACTOR ADDRESS: STREET /� PC 6e . / /ZGf 3 �, t}�- //, CITY tivQ,(/'j 1 f ' j/le STATE 1,4) ! ZIP re 7"' CONTRACTOR PHONE: e Z 5-" 27L-2 -J65'5 ( CONTRACTOR EMAIL:gtif ,&rt.1tD Quiht.Cj4fak&Ctt'we./4as PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ' if - 976—rOSs"l Piet,i 5w-1(3)/G‘V CONTACT EMAIL:j7L c'frw,I Cul W1(..'`s-/'..„7"iD„fI)9s .://(owl. MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $ ySi e70(' 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 O WORK: Cow#r„.. IJtc) 5 r" MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QtY) (QtY) A/C Unit(attach plan with location of outdoor unit) c'" 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 11. - 7aC) PERMIT# -^ t ��0 wner/Authorized gent Sig ature Date (Revised 2/8/2021)