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V <br /> • ` JUL 1 9 2022 1)) <br /> MECHANICAL PERMIT APPLICATION CITY OF EVERETT <br /> CITY OF EVERETT PERMIT SERVICES permit Services <br /> EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 Cedar treet 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET h t 1-t Ltj 1 1 4kj PARCEL#:0( O(h Cl.21oLtciL4 Qc)(V) <br /> CITY tA VI?r STATE (1 ZIP el q/�:11�� <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: I <br /> TENANT/BUSINESS NAME(if non-residential): ' j (-�f r-i K] Q , <br /> CONTACT INFORMATION <br /> OWNER NAME: L l i 1 U <br /> OWNER MAILING ADDRESS: STREET L L'i ` \T \li ' <br /> CITY QA ti STATE LOP` ZIP Clet I <br /> OWNER PHONE:U [j - -- OWNER EMAIL: Ly }�(� l�-t L[ HC ,( <br /> CONTRACTOR COMPANY NAME: }\L'( (C-t, ,6-A1-, Tt'{Y.1. 1(. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): e'l-� L ) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)--11 <br /> CONTRACTOR ADDRESS: STREET `,.�u3 \/ 1 ��yy <br /> CITY `[A N 1't")�Ik1,S1,-t STATE ZIP goo <br /> CONTRACTOR PHONE: "`1 CONTRACTOR EMAIL: `� <br /> PRIMARY CONTACT: ❑OWNER VI CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: y,� CONTACT PHONE: L(� StL 0 ( — <br /> 4 QQ_ViK&NI'T �V1,T�JT_ CONTACT EMAIL:UZZ'i � v___ A. r1)� •C cn <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$ L\ --a 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: y— � [. LA•T- <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 /> 9 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.) I Heat Pump(attach plan with location of outdoor unit) <br /> Compressbrs/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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# _CI <br /> I <br /> • uthorized Agent Si gnat r Date (Revised 4/21/2022) <br />