1021 100TH ST SW 2024-08-06 - Laserfiche WebLink

3 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 /0/ /00t , i PARCEL#: (Y/i3 coo WHO() ) CITY 5)0./C., STATE 40 ZIP 7gU7a SUITE/UNIT#: FLOOR#: (,) S/'�.'r- ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): `t� CONTACT INFORMATION OWNER NAME: 6.A0".14(0. Ct. f4wt Cofri-51✓wt CA.r OWNER MAILING ADDRESS: STREET PC) 6C / /Z y3 � CITY meal( STATE/ft J STTATE ♦✓f{�6y-[ ZIP 9?1 ]7 © OWNER PHONE: tZ s' - T 6-/r2 SJ ! OWNER EMAIL: GS�t.S fA/'ti1 (ckir `✓rt c1tJ1i"`Gf cCk� eC CONTRACTOR COMPANY NAME: /5zij t) 64A-Sf4544A C c4yW el-()sJ\ WA STATE CONTRACTOR LICENSE#(REQUIRED): fx.0 Ole&?15? 61ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S53 36 CONTRACTOR ADDRESS: STREET ,4je,x /L 11 CITY /4'e,y ,r(///`' STATE LA U% ZIP 19. O CONTRACTOR PHONE: 4Zs= .. 5- I CONTRACTOR EMAIL: g=�S{*vdl�j�(S u.7oz-tS�•L-tT'+¢a1 4'Nr'1,Yldw. g PRIMARY CONTACT: gOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT ME: CONTACT PHONE: S- f7 76—6rs Ltil./ GGS;40- CONTACT EMAIL:t s S'aCetiSTa'^LOtCdilet4C' J�l� .co ,„, 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: [ SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family -#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: 66'2511"-C.c (V e Lx) S K 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) 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) � 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 • ! 2 2'a 00Z/ PERMIT# A ^2-1 1 ^l -0 C Owner/Authorized Agent Signatur Date (Revised 2/8/2021)