Laserfiche WebLink
NNE <br /> 12 ME IANICAL PERMIT APPLITION <br /> EVERETT 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 /> • WASHIN�TON CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> l e or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET VA to Cot� Ave, PARCEL#: Od c(e2.LUe j 30 2c0 <br /> city /wl'!1 STATE W A zip n t <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): fI/I N(1 LemoN fist' <br /> t1 <br /> CONTACT INFORMATION <br /> OWNER NAME: f It 1%MGM W4wtS <br /> OWNER MAILING ADDRESS: STREET jL(cio gt10G • <br /> IS AVt NE *id 1t 3 i <br /> crrr &italic STATE Iglik ZIP q soor <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): LINVApkt,cis.k N1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): SAAOtt <br /> CONTRACTOR ADDRESS: STREET ?a(2-$- S S. c.LL ts,„ <br /> tiny SLw W STATE W* zip `i m/if`l <br /> CONTRACTOR PHONE: ?,E,(- 33 it- Ss°t CONTRACTOR EMAIL: $L'ttv,_ FA 'L8 Q 41400.COw1 <br /> PRIMARY CONTACT: CI OWNER SkONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206'1410 -9t1'12- <br /> 14CNtv1, Patel CONTACT EMAIL: yt PA,n 48 @ tMwt1.cowl <br /> MECHANICAL PERMIT INFORMATION • <br /> VALUATION OF WORK:$ 2.2i t2 0 9 ASSOCIATED PERMIT#(if applicable): '0 - °Z"033 <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: E,Commercial DAccessory Structure <br /> DESCRIPTION OF WORK: tt44-tuA1 9NNatAir- t vl coo'& 0, t eet.seir tot, comt000k rth W raj ftop <br /> Cove AMASAVI tMrh't r1 +>o-rr hill votyoea�or 9Covt• I h e0.4-vtrhtitoil lr�rPB - vt <br /> tt iouv a aktfvor laN6ts 0 <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 /> 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 manufacturers 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.lam the owner,or/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 /> Ti <br /> HlZt PERMIT#A_ _______N ro1/4,,,,,_f <br /> A^ 2I 01 -o � <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />