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MECHANICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off herd copy paper applioallon&plan 10 3200 Ceder Street 2nd Floor Intake Drop Box. <br /> vA0IIIfjorot4 CONTACT INFORMATION;(P)425,257,8810 I(E)everetleps@avareitwa gov)(W)averettwa,gov/pornilts <br /> (Blue or Wack Ink Only Pleas o) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:R190 emcerPARGELdel; 041.00$' 6Ue 6,0006 <br /> CITY 6 v`Ie aTAT9 It/rF' 21P <br /> SUITEIUNIT Vt FLOOR 1l: ADDITIONAL LOCATION INFORMATION; <br /> TENANTA3USINES S NAME(If non-residential): Royeit AAA <br /> CONTACT INFORMATION <br /> OWNER NAME; <br /> OWNER MAILING ADDRESS: sTscary 17 r' h V�' <br /> CITY V eO f t aTATa WA XIP 85-01 <br /> OWNER PHONE; JOWNER EMAIL,, <br /> CONTRACTOR COMPANY NAME: tC g lk-Af ch and 4&WA sTA'I rz CONTRACTOR LICENSE 1l(REQUIRED),, pV ,� 0"OF EVERETT BUSINESS LICENSE I!REQUIR[0): PC, ,7t7 r/w w f.�+ <br /> CONTRACTOR ADDRESS: wncar II d 0 e— <br /> CITY 'r vrl!t aTM 2113 f &Q <br /> CONTRACTOR PHONE; '� S"' AfoL^ 3 11y 10014TRACTOR EMAIL! /,Ff CSS w , C�/3'� <br /> PRIMARY CONTACT: CI OWNER CONTRACTOR CI OTHER(Please Spoolfy) <br /> CONTACT NAME: ICONTACT PHONE: S 76"f 0,3'y <br /> c' 1"r A,r.(r,- rt CONTACT EMAIL; �Sb/h w� � <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK;$ D , ASSOCIATED PERMIT 1l(If a lloabla): C ad 33 <br /> --- <br /> R4555stion shav include the provaillng for market vacuo or all ebor,mole a s,ana equ pmonl neo oo Co oont loco lho work,v of+or acluai Cola of not. <br /> BUILDING TYPE! ❑SFR []Townhouse 01)u lex CJARU DMultkranlil -4f Unite; rl-mmerclal ElAcco6soryl3truolure <br /> DESCRIPTION OF WORK! <br /> MECHANICAL PERMIT FIXTURE COUNT SCOPE OF WORK <br /> r lxturo FIX(aro <br /> count Liv otrixiuras Count Lfat offtturas <br /> {Qty) Qty <br /> AIC Unit attach plan Wali location of outdoor unit Gas Piping•list i!or oullets In fixture count <br /> Ar Handling Unit** Gas Appllanoo** <br /> Holler(most require backflow ravenilon) Gas Fireplace,Insert,end/or Loy *for commercial bldgs <br /> Commerole Refrlyerallon(welmn coolors,Vitt:,VRV,oto,) Gas-Other List T e: ** <br /> Commerolal Ventilation(oorddoro,aialrwou,ptowlizotion,ow.) Heat Pump attach plan wllh f000llon of outdoor unit) <br /> Compressors/Generators(bull tng pormll may bo roil trod) Heat Pump Ductless{attaoh plan Wl(h l000llon of outdoor unit) <br /> Clothes Dryer Exhaual Hydronlo Piping <br /> Duct system(addlllons,ol(orallons) Unit healer{commercla use <br /> Exhaust Fart(resldnntid or commorclal use) Water Heeler(gas or eleoirlc) i <br /> Exhaust Hood rasldontlol over stoveWood/Pellet Stove or Insert <br /> Exhaual Hood Type I*** Other(Llsl Type)! j <br /> Exhaual Hood Xo II*** Other(Llsl Type); <br /> Furnace rasidanliol Other I.IsI o <br /> * For commercial gas fireplaces,please aftach plans and monufootumea Inslalfatlon manuol, <br /> Vt* Under Description of Work,please Include Type of Equipment,model Na,ad detailed desoripllon of work,and the location of the equipment, <br /> *** Type I hood and Typo 11 lloods shall be on a stand alone Mechonloal Pomlll applloatton and requires plan review,Ploaso submit the required dooumonia as <br /> dosodbod In the assooleled Chookflols online at ovoroltwe, ovl ermits undor Iho Cheokllals&Handouts tab, <br /> C O JLM E 1= T.I hovo tovkwod INS opplice7ron and confirm file Information confolned flown Is two end corroof, dono pursuont to f T1s poWfl must cot rrplyWilli <br /> oarroof todorof,stafo,ondlooa?law.Tho iwonlinp ora perm!?only authorizos approved work and no dovietlons fheraftont.Bovlaffons nits;first bo authorized In wrifing from tho <br /> Building ONlolol betoro boing outhotizod under any olrotnnstanoo,!om tho owner,or I on)authorlrod by the ownor of fhla proporly to podwin tho work tot whloh oppdoaflon Is made, <br /> and r comply tvlth Tho Slate Controotors Law 10.27 ROW and 200.200A WAC. <br /> oily of✓~voroft O/Rorot use only <br /> PERMIT 1l <br /> Awtlor/Aut1wixed Agent Signature V mate (Revised 2021) <br /> I <br />