1017 100TH ST SW 2024-08-06 - Laserfiche WebLink

2-1 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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET (C i (oc) 5 f 5 w PARCEL#: 2 0 � 'f l3ot) �`tv 30 c� CITY C.0 e- STATE l.rt.1 4- ZIP 980-7 c4 SUITE/UNIT#: FLOOR#: (2,2 50F71 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: 3,1/45t'4vr1 Cw�� C „Jtjr9v� OWNER MAILING ADDRESS: STREET P z .c 1Z.1 CITY G�1� �.�t ,� STATE 03 ZIP 1.17_..7 OWNER PHONE: Llz.S c 7(o (.5c( OWNER EMAIL: 3cs�va � CLa �w� ,NSF r; k�e c./l) c;ltwsi I 0cr< CONTRACTOR COMPANY NAME: 13i..,1 u.J C s�s�.. C o SVv WA STATE CONTRACTOR LICENSE#(REQUIRED): Qusi• � cl Z L� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S 335(, CONTRACTOR ADDRESS: STREET 7, -2.2.4 CITY MC-Yr43 t i.c. STATE ()Q(\ ZIP 98Z7 0 CONTRACTOR PHONE: t4 (oSS/ CONTRACTOR EMAIL: 44 S �•„�( • 4r (`u(s lh 01(1:5 Y1LIA , t-6 4 PRIMARY CONTACT: .�WNER El CONTRACTOR ❑OTHER(Please Specify) J CONTACT NAME: CONTACT PHONE: Z5 1- r)(6 cf( c. ._.� —6t4E/A I CONTACT EMAIL: ? �vc1�c.S�bnnCrv�5Tw u�}tD�tiCC�3 S4ti�cv I-Lv�� MECHANICAL PERMIT INFORMATION �y VALUATION OF WORK: $ `� l 06C7 ASSOCIATED PERMIT#(if applicable): / J/1-b/�C; A m l g (Valuation shall include the prevailing fair market Value of all labor,ma..a,s,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: IASFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: rwc 1 (ve_ 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) s`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) 5—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 PERMIT# ^, ? 0 ner/Authorize Agen ig e ate (Revised 2/8/2021)