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MEA%ANICAL PERMIT APPLICAON <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />WASHINGTON <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plan to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.8810 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 10312 EVERGREEN WAY PARCEL #: 00535200001001 <br />CITY EVERETT STATE WA ZIP 98204 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): <br />CONTACT INFORMATION <br />OWNER NAME: SERJ DRIVE-INS WASHINGTON <br />OWNER MAILING ADDRESS: STREET 1500 EAST KATELLA AVENUE #5 <br />CITY ORANGE STATE CA Zip 92867 <br />OWNER PHONE: 657-223-9133 <br />OWNER EMAIL: JASMIN@SERJGROUP.COM <br />CONTRACTOR COMPANY NAME: TO BE DETERMINED n(, , <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />QCITY <br />CONTRACTOR ADDRESS: STREET 1 2D i/VV ', ZOO <br />CITY C t, I( u, STATE , ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR © OTHER (Please Specify) ARCHITFCT <br />CONTACT NAME: E R I C KO C H <br />CONTACT PHONE: 425-636-8006 x 105 <br />CONTACT EMAIL: ERIC@PADGi.COM <br />MECHANICAL PERMIT INFORMATION <br />VALUATION OF WORK: $ 85000 <br />1ASSOCIATED 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 />Mechanical hvac for new 1464 s.f. restaurant <br />MECHANICAL PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />A/C Unit (attach plan with location of outdoor unit) <br />Gas Piping - List # of outlets in fixture count <br />Air Handling Unit <br />F <br />Gas Appliance See. N13,0 and page 2 <br />Boiler (most require backflow prevention) <br />Gas Fireplace, Insert, and/or Log (* for commercial bldgs) <br />Commercial Refrigeration (Walk-in coolers, VRF, VRV, etc.) <br />Gas - Other (List Type): *�k <br />Commercial Ventilation (corridors, stairwell, pressurization, etc.) <br />Heat Pump (attach plan with location of outdoor unit) <br />Compressors/Generators (building permit may be required) <br />Heat Pump Ductless (attach plan with location of outdoor unit) <br />Clothes Dryer Exhaust <br />Hydronic Piping <br />Duct System (additions, alterations) <br />Unit heater (commercial use) <br />Exhaust Fan (residential or commercial use) <br />2 <br />Water Heater (gas or electric) <br />Exhaust Hood (residential over stove) <br />Wood/Pellet Stove or Insert <br />Exhaust Hood Type I <br />Other (List Type). - <br />Exhaust Hood Type II <br />Other (List Type): <br />Furnace (residential) <br />Other (List Type): <br />�F For commercial gas fireplaces, please attach plans and manufacturer's installation manual. <br />�rlilr 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: l 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. 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br />Eric Koch .w <br />Owner/Authorized Agent Signature <br />6/ 10/2021 <br />Date <br />City of Everett Official Use Only <br />PERMIT # m 2— 1 06 <br />(Revised 21812021) <br />