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MECHANICAL PERMIT APPLICATION <br /> PITY OF EVEWT PERMIr t3ERvtaFs <br /> E V E R E T T sUl31N)TTAi:INSTRUCT19NS;prop off hrd copy paper application&plan to 3x60 Cedar Stregt 2nd Flobr Intake Drop Boy.. <br /> wnaHi rooranl .0 'N l tNFORMATIONi(P)425.267:81810.((Ej everetteps oo6verettwa gov. 1'(W)ev8rettwa,gov/pertYlii6 <br /> (B1uQ. r BlaC,karknE please . < ::::.: <br /> Y } RRQ.(�CTIT t�EORMATI.ON <br /> PROJECT SITE ADDRESS: siR r.51 5. . J- C" PARCEL M <br /> CITY STA E V✓ xlp•. <br /> SUWTE10NIT#: FhQOR#: ADDITIONAL LOCATION.INFORMATION. <br /> TENANTIRU-INESS NAME(if Hort-rasi¢antfll): <br /> .. .. . . <br /> CbNTACT: 1 �'OfMATIION . <br /> OWNER.NAME: <br /> .. .. <br /> OWNER MAILINO.ADpRESS;. STREET S : ,rte� vtr <br /> CITY: V£r zip r1 <br /> OWNER PHONE: <br /> ,Z <br /> 4 OWNER EMAIL: .1' i t.14+.✓-��t. %� .. <br /> CONTRACTOR COMPANY,NAME! <br /> WA S'rATE CONTRACTOR LICENSE:#(t EttU.IREE3): r_ • t,: crry OR t vERE7T SUSINE$3 LIC;ENSI"#(Fit'i(1UIRE©)t. � <br /> CONTRACTOR ADDRES.$: siir � <br /> CtiY �"atv^.,� STATE 2lP :25 <br /> CONTRACTOR PHONES— <br /> 7. CONTRACTOR.EMAIL: 0 u�- .J L 1:' ►v-e <br /> PRIMARY CONTACT: Cl OWNER "CONTRACTOR [:].OTHER(Ploose Specify) . <br /> CONTACT NAME: CONTACT PHONE:rX <br /> CONTACT,EMAIL:(p��.�, .. <br /> t e .v�. <br /> PERIfIIIT 1NOIV1A'TI54 <br /> VALUATION OF•WORK: $.1-0-tv, ASSOCIATED PERMIT.'# f a piEcabie ; <br /> (YaluetbR shall de u q ttia prevai ng a market value of all labor;materiels,s e upment Awe to domplets.the Werk;Whether actually tmid or not, <br /> BUILDING T' PE: SFR ❑TOWnhouse ❑D.ti lox. ❑ADU ❑MUlti-Famil -#Units. ❑Commercial ❑Accessory Strucildre <br /> bESCRIPIfONOFWORK: V1 'e 4 6v41COC J�ivovpv''� —v,-& vi.ZTc" (U.v�v� , <br /> itll. l�ANiCq,4 PE�#IIh�T=FifXTURE NT(u. DP ::O <YiNOiI )<: <br /> Fixture Fixture' <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) ctty <br /> AIC Lina{attach ptan'.±ivith location of outdoor unit Gas t?ipin"-List#of outlets'to fiixture oou r1t <br /> Nr•Handling Unit*yir;.. (Das Applisnoe ik* <br /> Boller{most require bookilovr preventloGas.Flre lace,.lnserrt,and/or Log lk for commerolel bill s} <br /> Commercial.ROM In coolers,VRF,VRv,eta} Gas-Other(L1st,Type)t yF* <br /> Commercial Ventllatlon:(corndom,stairwell,pressurtzatlon;etc.) Heat Pump.(attaCh plan with Ipcaflon of outdoor unit): <br /> Compr"obts/Gene►atgrs(buildhg permit may be raquired).:t'rytr Heal Pump Ductless at <br /> tach.dlan N1tth ipCatton of.aptdbor.Unit): <br /> Clothas Oryer.Exhaus(: H dronic,Plpin <br /> D110t,Sy6tem(addOmi,eWa#o.Rs) Unit healer.(come erclal`use) <br /> Exhaust Fan(residential or 4ommerctal rise) Water.Heater fgds or electric) <br /> Exhaust Hood(residential ovar stove Wood/Palet Stove or Insert <br /> Ekhausf.Hood 7ype•I*** Qther(List T :e), Z J <br /> Exhaust Hood Type Il 91F*�k Other Exist Type); <br /> Furnace residential Other(List Type): <br /> * For commercial gas ftreplacee,please attach plans and mAhufaoluter's Installation rrianual. <br /> ** <br /> Under gescrlptlon ofWork,please Include Type:of Equipment,Model#'s;ad detailed.deScrlptign of work,end�the:location of the.equipment. <br /> Type l hood and Type 11:hoods shall be on a stand alone Mechanical Perml6application;'and requlres plan review.Please sutimlt Itle required doouirieitts'as <br /> *** described In the associated Checklists onlEne of everetlwa, oV/ milts;tinder..tha.Checkilsts.'8�.tiandouls tali: <br /> A KhlotNt FDCFh,I <br /> have reviewed <br /> .Co.. ia Lon macd confirm f e o.rpmatton.coptainfere n is irae an cbrrect.f Workonsail Irrsf baufhorizad fn vrdlcfnogm'fproyrpmWlrrentesfatA, tl/gawm/ uTfgo <br /> 8ul/ding Qclal befoebfgag <br /> rozdunderacl(oumstarto:torn he wnbr;orfamufhorizedDythaiDwnerof fhlappedy.16 pamthe <br /> and1complysm ce Work for which applJCeNoh ish <br /> ta. <br /> ode; <br /> ; the 18:27RCWand296.200A <br /> WAC; <br /> Pity of Evarett official we.omy <br /> PERMIT i/ <br /> 'YZ, r ���✓L oud�- /�,L it 0- o?// <br /> Owner/Authorized A ant Signature flats Rev1sed2l8/2021) <br />