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• <br /> 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 SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET / Jer"51(.v, /iy PARCEL#: r 3jci j 7 7o/t)0 5 <br /> (� <br /> CITY vei'e// SIAIE t4-1/4 ZIP qs2;2a; <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): A yy- 79p <br /> 1 CONTACT INFORMATION <br /> OWNER NAME:61DD4 wiovo +) (vu5r <br /> OWNER MAILING ADDRESS: STREET .70156- VIGL VA./ two <br /> CITY /cA /Q Jt vt f(^ STATE (.4 ZIP <br /> OWNER PHONE: `' OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: i(ereMt ,$ ,, <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): (�g�.1/TSC..95./,j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET 5-4 220 e S <br /> CITY �'� <br /> � �/)lll STATE 1�� ZIP 9q1 <br /> CONTRACTOR PHONE: �� , l—�0 �� ll CONTRACTOR EMAIL: �./��� VfP SLii/! C,9414 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR "OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: d._o4- 3—/G//'-/ <br /> &ej4-1( �� CONTACT EMAIL: �i �j�y f/ iS``U�GO 6A-'1/ l <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$ / coz' ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing air arket value of all labor.materials,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: Commercial EAccessory Structure <br /> DESCRIPTION OF WORK: <br /> �� �j��G21 I 1� (�r � 714i f > .=:-) ( 5 j �vt i„// ` ,kc Liff `i4l/ <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 /> k 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.govlpermits 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 /> PERMIT# 7A 14—�7,9•G <br /> uthorized Agent Signature Date (Revised 2/8/2021) <br />