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M4-IANICAL PERMIT APPLIIITION <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 /> WASHINGTON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink ?nlyPlease) PROJECT'SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 6003 23rd Dr W PARCEL#: 28040200302000 <br /> CITY Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):NetAlly <br /> CONTACT.INFORMATION <br /> OWNER NAME: TOC MANAGEMENT SERVICES <br /> OWNER MAILING ADDRESS: STREET 6825 SW Sandburg ST <br /> CITY Tigard STATE OR ZIP 97223 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:Emerald Aire,Inc. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):EMERAAI055BL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 022819 <br /> CONTRACTOR ADDRESS: STREET5108 D St NW <br /> CITY Auburn STATE WA ZIP 98001 <br /> CONTRACTOR PHONE:(253)872-5665 CONTRACTOR EMAIL:Permits@emeraldaire.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(253)872-5665 <br /> Halle Rios CONTACT EMAIL:permits@emeraldaire.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $6,144.0o ASSOCIATED PERMIT#(if applicable):B2103-044 <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: Install wall mounted mini split unit(OHP located on roof) in IT room, all work per plans. <br /> MECHANICAL PERMIT 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 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)** 2 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# <br /> le06(7016( M2,‘ 04 - oz1 <br /> Ow r/Authorized A nt Signature te (Revised 2/8/2021) 1 I Z <br />