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MECS\NICAL PERMIT APPLICAOON <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 /> W AS HINGTON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1001 Shuksan Way PARCEL#: 2804010030020 <br /> cry Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: Roof ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME (if non-residential):US FOODS <br /> CONTACT INFORMATION <br /> OWNER NAME: US Foods Inc <br /> OWNER MAILING ADDRESS: STREET PO BOX 30308 <br /> CITY CHARLOTTE STATE NC ZIP 28230 <br /> OWNER PHONE:(919)404-410o OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:MacDonald Miller Facility Solutions <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):MACDOFS808OS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 40665 <br /> CONTRACTOR ADDRESS: STREET 7717 Detroit Ave SW <br /> CITY Seattle STATE WA ZIP 98106 <br /> CONTRACTOR PHONE:(206) 768-4062 CONTRACTOR EMAIL:Permits@macmiller.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: A m m O I1 P BP CY� ry CONTACT PHONE:(206)768-4062 <br /> /� CONTACT EMAIL:permits@macmiller.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $21,000 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: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> DEMO(3)GAS/ELECTRIC ROOF TOP AC UNITS.PROVIDE 8 INSTALL(3)LIKE-FOR-LIKE GAS/ELECTRIC PACKAGED ROOF TOP AC UNITS.DISCONNECT/RECONNECT POWER E.GAS SUPPLIES.PER PLAN. <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (QtY) (MY) <br /> A/C Unit(attach plan with location of outdoor unit) Gas Piping-List#of outlets in fixture count <br /> 3 Air Handling Unit** Gas Appliance** <br /> Boiler(most require backflow 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*** Other(List Type): <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 information 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 I 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 /> City of Everett Official Use Only <br /> PERMIT# M I- D 5 ()© <br /> "'°"'°"'"""""Ammone Bembry a.�"" ' --"""-- 04/30/2021 ` <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) VZ <br />