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• • <br /> in MECHANICAL PERMIT APPLICATION <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 SITEyy INFORMATION <br /> PROJECT SITE ADDRESS: STREET Cie i fz ST. PARCEL#: OL y,301®<6O 2(fiba-bp <br /> CITY EV eiteett STATE W A ZIP 1C 2 01 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): CI CAA it\e B111+1" ' v V I Y\oi CA?. <br /> �n `��!l �/+�� yy� CONTACT <br /> OWNER NAME: ce a 4 f S I FCC- 11 1 C� 1 C�� e 1 t [ iY 1T LL le <br /> OWNER MAILING ADDRESS: STREET I &2LI w. mup1 n,Q 11 W 'N. y� <br /> CITY E Yr'e/t"" STATE Y�r/ 1 ZIP I 2.j 111 <br /> 1 <br /> OWNER PHONE: Li 2 -:•,- 2 6-2- 2 q OWNER EMAIL: VV <br /> CONTRACTOR COMPANY NAME: al ,C(3W le g En STC Sh�1QT m of L. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):V€RSS� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 75 9 cc <br /> CONTRACTOR ADDRESS: STREET 212.0 p V'l l it El c are C. <br /> CITY eve Ace;1 t STATE yr Of ZIP t�8+ fi�(//1 1 <br /> CONTRACTOR PHONE:L12..r 2 2 .1 i 4 CONTRACTOR EMAIL:-MN 16re ESSm�"ra cl,�Ill <br /> 1 <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR E OTHER(Please Specify) <br /> CONTACT NAME: 1 / �/ CONTACT PHONE: L 2L�1- 25'2 - Si i <br /> 1 it\� I UK el a Vr`E. CONTACT EMAIL: 'Fy tor 6£ wit• CCM <br /> `I MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$ a 1 3 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: Commercial ['Accessory Structure <br /> DESCRIPTION OF WORK: <br /> eep\ /i(-,le'J Eiisnn/',I tIV1+T hetriew in w+Ir/ehOu <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (QtY) (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 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 *** Other(List Type): <br /> Exhaust Hood Type II*** 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: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,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.1 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 17L I 11 0,-.("2( PERMIT, /� , 1 \ , IA <br /> Owned orized Agent Signature I Date (Revised 2/�8//2021) <br /> IllZ <br />