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ME•ANICAL PERMIT APPLICAION
<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 /> WASHINOTON CONTACT INFORMATION: (P)425.257.8810 (E)everetteps@everettwa.gov I(W)everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET 00 -3 �}Jp � Ct �(„0.0 '(�t� , PARCEL#: r b -( ( ODD V h�,(T)
<br /> CITY EA)411- STATE w�y ZIP l 1� /J 3
<br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: 40-12 lll�
<br /> TENANT/BUSINESS NAME(if non-residential): 11 -k 1\)Lil
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<br /> t7 1# CONTACT INFORMATION •
<br /> OWNER NAME: Vi--)DE Q:a1`AP 1 (V\O'Lt,
<br /> OWNER MAILING ADDRESS: STREET \ (. �'� ' 2j C.5-7 I✓1� to 0 _\3
<br /> (�{
<br /> CITY `Yt \ STATE . ZIP 1 a 1.4
<br /> OWNER PHONE: U W( — b\ i q OWNER EMAIL: � MU01 O. tTo l`MOY`in \tom-e 14\a,,,,
<br /> CONTRACTOR COMPANY NAME: VJM `{ \yn(, NCH
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):UQ ts-v.,Wr7j117-) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): a 4
<br /> CONTRACTOR ADDRESS: STREET 11 tok 001 ck, >3+
<br /> CITY Mk/VA C) STATE t),3 ZIP crc y-5---
<br /> CONTRACTOR PHONE: ')OW 'lL\ cSi 1 5 CONTRACTOR EMAIL: V.)YL1 111(' ()S l,,V\C\
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) 9
<br /> CONTACT NAME: CONTACT PHONE: -7�(� S '�('7)
<br /> CJ� CTn \-\ys\ (j\(/)\\(NS CONTACT EMAIL: ��l ry/)\AS v\ ,t r c'0-Th
<br /> MECHANICAL PERMIT INFORMATION
<br /> VALUATION OF WORK:$ 130,000.00 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: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Famliy-#Units: %Commercial ❑Accessory Structure
<br /> DESCRIPTION OF WORK: Remove and replace (2) DA heater vessels in the boiler plant of Boeing Building 40-12.
<br /> These will be rigged through holes in the roof with cranes.
<br /> MECHANICAL PER110 FIXTURE COUNT (SCOPE OF WORK) •
<br /> Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures
<br /> (Qty) (Qfy)
<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 /> Boller(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*** _2 Other(List Type): ')Lae„/'A,tY,Y Pm tor' _
<br /> Exhaust Hood Type 11*** 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:l 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!am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> Digitally signed by Brittney Higgins City of Everett Official Use Only
<br /> v.+� ttCxL sBrittney Higgins,o g nc.,ou=Special PERMIT# In V^1 I 0
<br /> o,. A, M S Project Group,email=bhigins@umci.com,c=US
<br /> j / os.2112:21:45-07'00'
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<br /> (own'�r/Authorized •s it Sigt uV�e Date (Revised 2/8/2021)
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