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EVERETT <br />WASHINGTON <br />MECHANICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <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 Mk Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 1505 - 112th Street SW PARCEL #: 00442900301400 <br />c,TY Everett STATE WA zip 98204 <br />SUITE/UNIT #: N/A FLOOR #: 1 ADDITIONAL LOCATION INFORMATION: N/A <br />TENANT/BUSINESS NAME (if non-residential): Centro Palabra VIVlente Church <br />CONTACT INFORMATION <br />OWNER NAME: Pacific Northwest Annual Conference of The United Methodist Church <br />OWNER MAILING ADDRESS: STREET 816 S 216th Street, Unit 2 <br />c,Ty Des Moines STATE WA zip 98198 <br />OWNER PHONE:206-870-6820 <br />OWNER EMAIL: <br />CONTRACTOR COMPANY NAME: D. K. Systems, Inc <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): DKSYSI*982L1 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 049744 <br />CONTRACTOR ADDRESS: STREETPO Box 886/ 962 S. Spruce Street <br />c,Ty Burlington STATE WA z,p 98233 <br />CONTRACTOR PHONE:360-755-1 555 <br />1CONTRACTOR EMAIL: dulce@dksysterYlslnc.corn <br />PRIMARY CONTACT: ❑ OWNER ✓❑ CONTRACTOR El OTHER (Please Specify) <br />CONTACT NAME: D U I Ce Herrera <br />CONTACT PHONE:360-755-1555 <br />CONTACT EMAIL:dulce@dksystemsinc.com <br />dksystemsinc.com <br />MECHANICAL PERMIT INFORMATION <br />VALUATION OF WORK: $80,000.00 <br />1ASSOCIATED PERMIT # (if applicable):B2012-005 <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 />Install (1) Split System, (4) Package Units, and (1) Ventilation Unit - ERV <br />MECHANICAL PERMIT FIXTURE <br />COUNT SCOPE OF WORK) <br />Fixture <br />Count <br />MW <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />4 <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 />Gas Appliance ** <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) itlt <br />1 <br />Commercial Ventilation (corridors, Stairwell, pressurization, etc.) <br />1 <br />Heat Pump (attach plan with location of outdoor unit) <br />Compressors/Generators (building permit may be required) tllnik <br />1 <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 />lWater Heater (gas or electric) <br />Exhaust Hood (residential over stove) <br />Wood/Pellet Stove or Insert <br />Exhaust Hood Type I **ik <br />Other (List Type): <br />Exhaust Hood Type II *** <br />Other (List Type): <br />Furnace (residential) <br />Other (List Type): <br />* For commercial gas fireplaces, please attach plans and manufacturer's installation manual. <br />1t* 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 />an mply with the State Contractors Law 18.27 RCW and 296.200A WAC <br />/7 n City of Everett Official Use Only <br />PERMIT # _ f� <br />Dupce Herrera 07/19/2021 v <br />Owner/Authorized Agent Signature Date (Revised 21812021) <br />l`J <br />