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E MANICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box.
<br /> wnsHIHOTON CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwagov I(W)everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) • PROJECT SITE INFORMATION •
<br /> PROJECT SITE ADDRESS: STREET .) 00'3 Q� (..`3c1 t(t.() '2.t , PARCEL#: t 1-4 ( (D0\( ) (T)
<br /> CITY FAA Pa • STATE W ZIP (IC( a p H
<br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: 45-07
<br /> TENANT/BUSINESS NAME(if non-residential):`apt • 1‘..)(,1 QOIJ\?WLi
<br /> CONTACTA INFORMATION
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<br /> OWNER NAME: % .� 0L1 • C..C:*IkPA Y' 1 C4 O 1�8 . �1 t'v\0Nr t,tl1 ....
<br /> OWNER MAILING ADDRESS: STREET �,0, Q-,t 3;-j cr1 M41g u 0t -\?'
<br /> CITY �,0'tt STATE V-5' ZIP 1 a 1.4
<br /> OWNER PHONE: LA ` -t,2 Lots — b\ 1,1 L OWNER EMAIL: \ , (V\(M.a O.&a?l YV\t3r l f\�'7t7 X \r�
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<br /> CONTRACTOR COMPANY NAME: J C f \y\C„ ^
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):uQl\J�M(',Wr�jt13 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ( a 4
<br /> CONTRACTOR ADDRESS: STREET t\lg\ Lkt\1 t Vt, u3.
<br /> CITY MU NA V\L0 STATE l),1/4.1 NC ZIP eicc a-7'5
<br /> CONTRACTOR PHONE: )Dt() `1O\U cii D ) CONTRACTOR EMAIL: \r•All(5('i(r �v\C `n t a1 , C�Q' -)
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) �J
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<br /> CONTACT� NAME: 1 CONTACT PHONE: 9 �4 `-lq q ' —1 o?)
<br /> CJ\C l V1C., Y U\Q)\(S CONTACT EMAIL: fr1 Cn(/� os @O Ui v\t„i, c'�'�
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<br /> MECHANICAL PERMIT INFORMATION : ` . •
<br /> VALUATION OF WORK:$35,000.00 ASSOCIATED PERMIT#(if applicable):
<br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.)
<br /> BUILDING TYPE: DSFR 0Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: �ICommercial ❑Accessory Structure
<br /> DESCRIPTION OF WORK: Remove and replace (1) DA heater vessel in the boiler plant of Boeing Building 45-07.
<br /> Heater will be handled inside the building with crane and rigging from existing structure.
<br /> MECHANICAL PER FIXTURE COUNT (SCOPE OF WORK)
<br /> Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures
<br /> (Qty) (Qty)
<br /> A/C Unit(attach plan with location of outdoor unit) Gas Piping-List#of outlets In fixture count
<br /> Air Handling Unit** Gas Ap Hance**
<br /> Boiler(most require backfiow prevention)** Gas Fireplace,Insert,and/or Log(*for commercial bldgs)
<br /> Commercial Refrigeration(Walk-in coolers,VRF,VRV,etc.) Gas-Other(List Type): **
<br /> Commercial Ventilation(corridors,stairwell,pressurization,etc.) Heat Pump(attach plan with location of outdoor unit)
<br /> Compressors/Generators(building permit may be required)** Heat Pump Ductless(attach plan with location of outdoor unit)
<br /> Clothes Dryer Exhaust Hydronic Piping
<br /> Duct System(additions,alterations) Unit heater(commercial use)
<br /> Exhaust Fan(residential or commercial use) Water Heater(gas or electric)
<br /> Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert
<br /> Exhaust Hood Type I*** 1 _Other(List Type): N..c1e,f&. o-v Wc,.ake.v- _
<br /> Exhaust Hood Type II*** Other(List Type):
<br /> Furnace(residential) _ Other(List Type):
<br /> * For commercial gas fireplaces,please attach plans and manufacturer's installation manual.
<br /> ** Under Description of Work,please include Type of Equipment,model#'s,ad detailed description of work,and the location of the equipment.
<br /> *** 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
<br /> described In the associated Checklists online at everettwa,gov/permits under the Checklists&Handouts tab.
<br /> ACKNOWLEDGEMENT.:I have reviewed this application and confirm the infonnation contained herein is true and correct. Work done pursuant to this permit must comply with
<br /> 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
<br /> Building Official before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> f City of Everett Official Use Only
<br /> Digitally signed by Brittney Higgins I /n
<br /> /� A F c DN.ccts-GrtneyHiggins,ogins@lnc.,ou=Special PERMIT# iI D W
<br /> I �7:;P.ro ects Grou email-bhi i1 n
<br /> qf---Alickg.y t,� j p, ggins@umci.com,c=US /V t,
<br /> 1 1 at• 05.21 12:19:47-07'00'
<br /> (L1war/Authorized 't it Sigi uYe Date (Revised2/8/202i)
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