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161 MEOIANICAL PERMIT APPLICION <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)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 5901 23rd Dr W PARCEL#: <br /> crry Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: Ste 102 FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): Bridgeways <br /> CONTACT INFORMATION <br /> OWNER NAME: Ed <br /> OWNER MAILING ADDRESS: STREET 5901 23rd Dr W Ste 102 <br /> cry Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425-387-2272 OWNER EMAIL:ewilkins@bridgeways.org <br /> CONTRACTOR COMPANY NAME: Evergreen State Heat&AC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):EVERGSSO22OT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 007955 <br /> CONTRACTOR ADDRESS: STREET 8431 Maltby Rd <br /> crTY Snohomish STATE WA ZIP 98296 <br /> CONTRACTOR PHONE: 425-252-31 14 CONTRACTOR EMAIL: cliff@essmwa.com <br /> PRIMARY CONTACT: ❑II OWNER <br /> �.J CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:C I I 1 I An l.�a I^SO n CONTACT PHONE:425-252 3114 <br /> CONTACT EMAIL:cliff@essmwa.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $15,002.50 ASSOCIATED PERMIT#(if applicable): NA <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 /> RTU Replacements <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (CRY) (QtY) <br /> NC 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 *** J Other(List Type): R T(1 <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,sta e,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 ore b 'ng 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 e Contra s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 5/12/2022. PERMIT# M 220� '04,3 <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />