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! i! <br /> INN <br /> MECHANICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper appl cation&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> w45HVNGTON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps©everettwa.gov I(W)everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREE' �L 5W emr,aei* & \ [��► PARCEL#: 4SO4,1.4.{+fit'tO goor <br /> cm eqe e. urt L A. " 8�"1 <br /> SUITE/UNIT#: M `pr. FLOOR#: a IA ADDITIONAL LOCATION INFORMATION: p4 1 A <br /> TENANT/BUSINESS NAME if non-residential): Ns.s6ttsEe_ A e��, WIN <br /> CONTACT INFORMATION <br /> OWNER NAME: Cp j-� Z . t� <br /> OWNER MAILING ADDRESS: STREET ►3 az.3 .53r• • Aj <br /> r1T Ark( c,c‘A-0 sr;s,r 1.4)A is 18443 <br /> OWNER PHONE: LI 3144. i I �r I lOWNER EMAIL: cays- ‘tkLo. Qv `® . C2)rcv <br /> CONTRACTOR COMPANY NAME: 1es Cjrvs-r(wev\t c' <br /> WA STATE CONTRACTOR LICENSE#(REOUIRE6XSCOCD 011C2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): %ASO <br /> CONTRACTOR ADDRESS: STREET v,� X S'c3o3 w <br /> CITY Li y,' l,Jo& =-ATE 4 zts 98 V 04 <br /> CONTRACTOR PHONE:/ZaS -"tit" ogD..(4,, CONTRACTOR EMAILTt4 's QSLO 1 *in .C°CY\ <br /> PRIMARY CONTACT: tl OWNER .ONTRACTOR 7. OTHER(Please Specify)_ <br /> CONTACT NAME:Tre, t'¢ rSOv.. CONTACT PHONE: Z O 6 619 SS ZL <br /> Y CONTACT EMAIL: —They y ,`�. ..V.�o{v♦t c 40 6.a y • Coy^. <br /> •- MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: S'1'.1)0L * i1 yi ASSOCIATED PERMIT#(if applicable): t4's 'SSved ye-t- <br /> /Valuatron shall inuluae the prevailing fair market value el at labor.materials,and equipment needed to complete the work.vheteer actually paid nr nor.l <br /> BUILDING TYPE: ❑SFR 1Townhouse ['Duplex ❑ADU Mulh-Family-#Units: WCommercial L)AccessoryStructure <br /> DESCRIPTION OF WORK:-9/e n t4c. r � e.Y.t SlIKA Qo r►* (poem'µ t4-/C 4,/-_5 p& —Zyl(4Oq -Crvl, <br /> And (h1C -1Zc.� (AM fL�J-09 12 9-3 IWi reQ,r-s—V ►^4o.Dr tack—Aker) <br /> MECHANICAL.PERMIT FIXTURE COUNT(SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> ((Ny) (Qty) <br /> NC 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,andior Log(*for commercial bldgs) <br /> Commercial Refngeration(Walk:n coolers.VRF,VRV,etc.) Gas-Other(List Type): ** <br /> Commercial Ventilation(corrtdors,stairwell pressarisatinn,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 Fleater(gas or electric) <br /> Exhaust Hood(residential over stove) Wood/Pellet Sto or Insert <br /> Exhaust Hood Type I*** Other(List Type telei3'C rc"\\ <br /> Exhaust Hood Type II*** 1 Other(List Type): /Vt <br /> Furnace(residentait 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 t hood and Type tl 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.stale,and focal law. The gr: inp o • -emit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from.the <br /> Building Official before being authorize* •der any ci umstance.lam the owner,or t am-authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with th• = e Con ac- s aw 18 27 ' W and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> �' ' 2 Z �m210�— b 9)Z <br /> Owner/Authori :d Agen gna Dat (Revised 2/8/2021) <br />