5901 23RD DR W BASE FILE 2022-03-03

ma MECNICAL PERMIT APPLICAOJN CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits WASHINGTON (Blue or Black Ink Only Please) PROJECT SITE Y,INFORMATION PROJECT SITE ADDRESS: STREET 5101 2� 'V t V PARCEL#: 21 Loi-j'it. CITY Eve IQ Q ft STATE w a ZIP 1 T2 0-3 SUITE/UNIT#: 101 FLOOR#: ' ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): l o p en. q / CONTACT INFORMATION OWNER NAME: 2a p ,n-esqy OWNER MAILING ADDRESS: STREET Vi 01) .25rd 1 ^� {� pi CITY Eve 6/ STATE WCif ZIP ° [,^y' J OWNER PHONE: jL OWNER EMAIL: y CONTRACTOR COMPANY NAME: `V erg 2€ /f) S 1 �I 1 ghee(' 1nb WA STATE CONTRACTOR LICENSE#(REQUIRED):EVVg SS02201-CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):?I s S CONTRACTOR ADDRESS: STREET 2.1r-Lo Pc f ci 1 wG V V�" ,^f ZIP �2�� CITY� t V ele I �ry� STATE CM V O� �+� yy� ��yy� CONTRACTOR PHONE:4'LGj- 2c2'� I L CONTRACTOR EMAIL: 1 4410 e e�`L�I t v a. am '_ PRIMARY CONTACT: ❑OWNER KCONTRACTOR ❑OTHER(Please Specify) CONTACT�j NAME: , �(�,Q CONTACT PHONE: ge25-'2S 2 5)I4 Ta1j1 UR 131 of r CONTACT EMAIL:ej(qiore esm •C Vfl MECHANICAL PERMIT INFORMATION VALUATION OF WORK:$ 2 V) '20L0 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 ❑Multi-Family-#Units: i commercial ❑Accessory Structure DESCRIPTION OF WORK: in gf ( atitn `I) � � m t'i i Sjf 1 1 GA w cin T.sS 5�� €A1S in s-re- MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (MY) (QtY) A/C Unit(attach plan with location of outdoor unit) 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) (List Other- Type):Commercial Refrigeration(Walk-in coolers,VRF,VRV,etc.) Gas Yp ): ** Commercial Ventilation(corridors,stairwell,pressurization,etc.) Heat Pump(attach plan with location of outdoor unit) Compressors/Generators(building permit may be required)** fL 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**fie Other(List Type): Exhaust Hood Type II glr*9r 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. 'rCity of Everett Official Use Only r PERMIT#,�,�1 it2 1 U_ 047 l Jr/1 Owner/Authorized Agent Signature Date (Revised 2/8/2021) 0