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E ME.NICAL PERMIT APPLICA•N
<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 /> WASHIMGTON CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I(VV)everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET I ''Z WA-1�j J oil- -C y 5 —- PARCEL#: A-Ax 1+91* o u 43:6 3y. .oc,-1-o1
<br /> CITY STATE V/A- ZIP 451 92i0
<br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION:
<br /> TENANT/BUSINESS NAME(if non-residential): r.t/Nt �.v,,i 9r704I cr .4- 12-e, I.,.j t A --/,41-1 o S, r-
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 't 2 WA-N-tic o.:C - -- , LA.,c.— vt/A
<br /> OWNER MAILING ADDRESS: STREET S Z sr3 /h9vJAS/ �t
<br /> CITY - ---C.e>t t-A STATE V/v4 ZIP a '6 4 C''-
<br /> OWNER PHONE: (ate) -:")---( Z4 OWNER EMAIL: cAb -a,t.(M 4-1.411I) Jiv)Jc a-).reiViuc;, L-O
<br /> CONTRACTOR COMPANY NAME: 0 VJ N 0 0/1 L-2 YL i t i :�Td V- Y-4-1 r S J sL
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): \A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1'-S A
<br /> CONTRACTOR ADDRESS: STREET l b �j a 1 % p use E; S. 'vJ
<br /> CITY \ ,,,,},..c pi 1/4/j,gcs7 aSTATE WA- ZIP q PC--
<br /> CONTRACTOR PHONE: C4- )3 ---eiG1 2-4' CONTRACTOR EMAIL: W r1 e\V CJa_-v I.. z-o,,,
<br /> PRIMARY CONTACT: IA OWNER ❑CONTRACTOR W OTHER(Please Specify) 12-09- —t C ris-(4._,
<br /> CONTACT NAME: ►s tea;b»s:-ts; V• >'".sc».cyr.._ CONTACT PHONE: (-i 2 -1-- -3-—g t I
<br /> C l vs) 1-1-,Ca,el 2-e-9- CONTACT EMAIL:
<br /> MECHANICAL PERMIT INFORMATION
<br /> VALUATION OF WORK:$ 1"00 6 "- 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 YDuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> DESCRIPTION OF WORK: _ 'j 7/A/-IA-3--
<br /> 6'JV,z,12T N^1.,( e.-f-- et.-%.B,-eA /k.ccv,•r,.1-1- i3vi1. g,.sc. •rr3 A- 'oA4 '-
<br /> ef-00i Arc') 'J2� rr 4_ _. -_ _ T y-`r-6 - -l J,e_oi.� - — i ii,/v u
<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 /> orCompressors/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 lectrlc 't p,,, -t,Q,5 5
<br /> f Exhaust Hood(residential over stove) Wood/Pellet Stove or I
<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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> C6-4..._ ��i 7/' i 2 2 Z Z2o 01 �
<br /> o--
<br /> ner/Authorized Ag t Signature Date (Revised 4/21/2022)
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