8609 EVERGREEN WAY COMMUNITY HEALTH CENTER 2022-10-14

MEHANICAL PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS: OF EVERETT PERMIT SERVICES Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 8609 Evergreen Way PARCEL#: 28041300102900 CITY Everett STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: 2 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Community Health Center of Snohomish County CONTACT INFORMATION OWNER NAME: Community Health Center of Sno County OWNER MAILING ADDRESS: STREET 5929 Evergreen Way,Suite 200 CITY Everett WA STATE ZIP 88203 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Evergreen Refrigeration WA STATE CONTRACTOR LICENSE#(REQUIRED):EVERGRL954R2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 044350 CONTRACTOR ADDRESS: STREET727 S Kenyon St CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE:206-763-1744 CONTRACTOR EMAIL:alexb@evergreenhvac.com PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:Alex Burkhart CONTACT PHONE:206-763-1744 ext.247 CONTACT EMAIL:alexb@evergreenhvac.com MECHANICAL PERMIT INFORMATION'. VALUATION OF WORK:$8,833.00 ASSOCIATED PERMIT#(if applicable):B2112-009 (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: ❑✓Commercial EAccessory Structure DESCRIPTION OF WORK: Installation of ductwork and grilles/diffusers. MECHANICAL PERMIT FIXTURE COUNT(SCOPE OF WORK); Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) ((NY) 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) Commercial Refrigeration(Walk-in coolers,VRF,VRV,etc.) Gas-Other(List Type): ** Commercial Ventilation(corridors,stairwell,pressurization,etc.) 'Heat Pump(attach plan with location of outdoor unit) Compressors/Generators(building permit may be required)** 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*** Other(List Type): Exhaust Hood Type II*** 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. City of Everett Official Use Only 2/24i22 PERMIT# 1 - - G,_2_ - 0 Owner/Authorized Agent Signature Date (Revised 2/8/2021) '�