5901 23RD DR W PROVIDENCE 2023-05-22

MEVANICAL PERMIT APPLIC.ION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 (E)PermitServices@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5901 23rd Drive W#105 PARCEL#: 01118500000500 CITY EVERETT STATE WA ZIP 98203 SUITE/UNIT#: 105 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential):PROVIDENCE HME CONTACT INFORMATION OWNER NAME: SEAWAY CORPORATE LOT 3C OWNER MAILING ADDRESS: STREET 4932 NE 97TH STREET CITY SEATTLE STATE WA ZIP 98115 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:AIR MANAGEMENT SOLUTIONS LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):AI RMAMS952QM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): APPLIED CONTRACTOR ADDRESS: STREET5822 W WERNER RD CITY BREMERTON STATE WA z,P 98312 CONTRACTOR PHONE:360.479.6500 CONTRACTOR EMAIL:OFFICE@AMS-HVAC.NET PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) AB L I TT CONTACT PHONE:360.479.6500 CONTACT NAME:S C OTT CONTACT EMAIL:SCOTTA@AMS-HVAC.NET MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $64,000 ASSOCIATED PERMIT#(if applicable): (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 ❑Accessory Structure DESCRIPTION OF WORK: install 2 ductless splits, 5 radiant tube heaters, 1 Doas ERV, 1 exhaust with make-up air louver. MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qhr) (Qty) 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)** Z, Heat Pump Ductless(attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronic Piping _ Duct System(additions,alterations) 5 Unit heater(commercial use) 1,_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. ACKNOWLEI EMENT: . eviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federa state,an'.loca law. .e granting of 'per.it only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Offic:l b-for: b g a thorize. under any 'ircum•ance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, d 1 comp, it 1 the'.t - o'tractors Law 18.2 RCW a d 296.200A WAC. City of Everett Official Use Only d,pr PERMIT# Owner/Aut'•rized Ag. t Signature Date (Revised 4/21/2022)