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E ME1ANICAL PERMIT APPLICAON <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 /> , <br /> PROJECT SITE ADDRESS: STREET 1\6 1.5 A I t2FORzi iZ.CI t PARCEL#: 0053 ?T0000 s q0 2 <br /> CITY G t/k iZ(src STATE iN F'1 zip !82 O y <br /> SUITE/UNIT#: FLOOR#: Isl. ' ADDITIONAL LOCATION INFORMATION: (4 VAC u/ti f7$6-As f SIP <br /> TENANT/BUSINESS NAME(if non-residential): S O N R\SE. C h IZ I S \ / N L L N f l: c f g,-//4e/4-/ <br /> CONTACT INFORMATION <br /> OWNER NAME: ,j Q/V/a/S6 <br /> OWNER MAILING ADDRESS: STREET 511:1r3 As Pr10-Ecr A c-!r -_s <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):OLYMPV\I t7 OO I. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O I?:L 6.0 <br /> CONTRACTOR ADDRESS: STREET Z(718 G 6 4 Q 1/C 5-0;* Z -7 CITY 1 d uli twit_ I L 2(2A CC( STATE 6/V f� ZIP q$Ott,L 3 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: (e----t•-•-\‘CONTACT: D OWNER Ly CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 41 ZS 3 4 44 9(tf/v Ce-tt. a LS 77Y 88L}I of 64 c: <br /> S-t2✓Q (✓ L O6r? CONTACT EMAIL: S1EVE q OL Y)ii)°IC.Mcrc N A N I CAL . Co l':li <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $ //41 i vzi eJ 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-Family-#Units: I.�JCommercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: GA-Pcswt9N (61.7 <br /> ! -/\( -tv //V0' L/ter 1 # 7 -tie/4 s/'?b / 0 c:' 74.43.;s /N ter.K/rgre-N_ ( ,Ui,/- <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qt1) (QtY) <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 /> Boiler(most require backliow 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),r11l.I1 t2. t;m Water Heater(gas or electric) <br /> Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert <br /> Exhaust Hood Type I*** I Other(List Type): PAc-KAc,-57 (s(4 j //t,<c.7 L1 c I-1 VAS_c/fv IT <br /> Exhaust Hood Type II*** ( Other(List Type): O S ra S u?Pi 4 F A tl (t 15 lk i, <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:I have Ali-wed 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 loc. 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 beinc aut •rized under: 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 with the Ste:Co rectors Law : '7 RCW and 296.200A WAC. <br /> J L/ City of Everett Official/� Use Only <br /> (� <br /> '�, 0 3lr <br /> /Y94 PERMIT# A n 2-7— © 4 l/�/ Z <br /> Owned •nzed • t Signature Date (Revised 2/8/2021) , <br /> ( Z <br /> r <br /> r <br />