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E ME dANICAL PERMIT APPLIC/ ON <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 Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET ��J I Lb HO 1 PTV co„, PARCEL#: <br /> Z4)Z L, J---�(NJ� � CITY '� �%�"Y— We(STATE � ZIP g�Z O/ <br /> SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): E Cl <br /> CONTACT INFORMATION <br /> OWNER NAME: E i-c c1bt2 <br /> OWNER MAILING ADDRESS: STREET f�2,4 \`-)'d v+ I'� <br /> CITY !�v'Af 4 ( STATE \J A r I ZIP . I <br /> OWNER PHONE: 3 (7l/ /2�45"' 2 1 2` OWNER EMAIL: Ff.Ik �/`t-c; YYY�"' �1�?tr e - e/7 Aleii Leo) <br /> CONTRACTOR COMPANY NAME: i7//�r 6)eci- 2'.4/c� t I <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):: /yobs CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62 i s\ <br /> CONTRACTOR ADDRESS: STREET j 3 7 tVG r-cC ii E _ [� <br /> CITY j^ (1,d-�/� STATE Y v ZIP / <br /> CONTRACTOR PHONE:3 IZN--'V I! -��bb) CONTRACTOR EMAIL: / et..../-,,d r/)rj c,1 tndI.6 v awyt <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME::// CONTACT PHONE: 3 — 'G — &NOG <br /> ` ��IY K/21‹ <br /> CONTACT EMAIL: Kr ' ( /f'tf/1G4�71/IG'C..)-rete'1-4...1,C0:41 <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $ yl0 OD10 ASSOCIATED PERMIT#(if applicable): 1 ,2 VJ 1 O 3 — 0 �' <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually p 'd or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: VCommercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: ✓/r )/ •f r ], ` r r YV1 I �e t <br /> ._lam-✓�!j�-�,f J�jlP>✓ I n�� G 7��'` r �y�i k��f�C� �Z ` � ��.1 <br /> e�YVt 1-�- ". ---'0 N-- •ram. /,�, b <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <br /> NC Unit(atta-,h plan with location of outdoor unit) Gas Piping-List#of outlets in fixture count <br /> I 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 /> I Exhaust Fan(residential or commercial use) Water Heater(gas or electric) <br /> Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert <br /> q 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 alono 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 bef. • .eing authori -d 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 :to Contr.ct, s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /�-� - 7, ii- Zi IPERMIT# <br /> , ^ 7, 107 <br /> , 1 0 7 _ 0 +g <br /> Owner/Author' d Agent Signature Date (Revised 2/8/2021) f <br />