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MEOANICAL PERMIT APPLIC*ION <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 l(E)everetteps@everettwa.gov l(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1420 80TH ST SW PARCEL#: 01056800200500 <br /> crn Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: SUITE C FLOOR#: Roof(RTU) ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):Compendium <br /> CONTACT INFORMATION <br /> OWNER NAME: SMITH 1420 80TH STREET E LLC <br /> OWNER MAILING ADDRESS: STREET 1420 80TH ST SW HUDGING 2 SUITE E <br /> CITY EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:PSR Mechanical <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PSRMEML809C6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 018564 <br /> CONTRACTOR ADDRESS: STREET 3132 NE 133rd St <br /> crry Seattle STATE WA ZIP 98125 <br /> CONTRACTOR PHONE:206-573-6130 CONTRACTOR EMAIL:Chris.Stone@psrmechanical.com <br /> PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: Chris Stone CONTACT PHONE:206-573-6130 <br /> CONTACT EMAIL:Chris.Stone@psrmechanical.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $9491 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 /> Replace existing Gas Pack Rooftop Unit (AC-5). New unit requires Curb adapter. <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (QtY) <br /> t 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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �� /f J] /J J PERMIT# 1 S2 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />