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MECHANICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E V E R E T T SUBMITTAL INSTRUCTIONS:Drop off hard Copy paper application&pian to 3200 Ccdur Street 2nd Floor Intake Drop Uox. <br /> WA91 1NnTON CONTACT INFORMATION:(P)42.5.257.8810 1(F)everellops(a)uveto1Iwa.gov I(W)uvurullwa.(lov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STRECT AMA PARCEL M <br /> City ,T,tr 4 zr,C • 'Z C 2� <br /> SUITEIUNIT M FLOOR ff: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-rosidonlial): <br /> CONTACT INFORMATION <br /> OWNER NAME: ))1 ►� (�' <br /> AWASTATE <br /> NG ADDRESS: 3TAEET 7 2C)+ <br /> 1 OFx'I Cl✓ <br /> NE: 't7 - 306 - ? OWNER EMAIL: <br /> R COMPANY NAME:C. ��++ <br /> ONTRACTOR LICENSE N(REOUIRED):CbZ ii7Y OF EVERETT1)l1SINESS LICENSE q(It l)lllftE 0); OR ADDRESS: STREET O X7Ll <br /> City alt.( w(wTo tN STATE 2p\,, <br /> CONTRACTOR PHONE:340 CONTRACTOR EMAIL: o�114T C U CSS <br /> PRIMARY CONTACT: LJ OWNFR 1�ICONTRACTOR n OTHER(Please Spncify) _ <br /> CONTACT NAME: ICONTACT PHONE: C -V,fl):317 <br /> ULC STO � CONTACT EMAIL:( �r ` r. C :a•1Y'Urh G1Ct•'�1Gflrlf+t <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: ASSOCIATED PERMIT#(if n plicablo): <br /> (Vo'uot on cha l lr_'udo tto ptovart,p'ar rra of vavo or at fmw,moto7515.ono equ orropt ncct"to cm,ivo tao%r4.wictow aouiry FT5 or as) <br /> BUILDING TYPE: CISFR LlTownhouso ❑Duplex AADU t7Mulli-Fumil •If Units: LIConiniercial FlAccassoryStrtirturo <br /> DESCRIPTION OF WORK: W WiPii ► ICAI R.Pr Vk <br /> MECHANICAL PERMIT FIXTURE COUNT(SCOPE OF WORK) <br /> Fixture rixturn <br /> Count List o/Fixturos Count List of Fixtures <br /> (Q N) Qt <br /> AIC Unit(attach plan wth location of outdoor unit) Gna Piping•List 17 0l outlets In 6xluro cn�nl <br /> Air Har•,dl'ng Unit** Gas Applinneo** <br /> fto'.cr(mos(roquiro hae-Oto r proven'inn)** Gus Fhuptucu,Insett,tuxlror Lull(*for commorcinl blips) <br /> Ccmmercial Rofrigeral'ol(vva x to coo'ers,VRr,VRV,etc.) Gnn-Other(List Typn): ** <br /> yL Commerdal Vontiln:Ion(wr&n.,rti enol,rresnru.+5rn,etc.) Hoat Pump(attach plan Wth location of ewldwr un'1) <br /> i\ CompessolSIGenuratcrs(Warhol perntR may lw ler urod)** Heat Pump Ouctloss(ntlarh plan Wth loa-iboo of outdoor unit) <br /> Cln:hes Oryor Exhaust Hydronic Rpmg <br /> Cucl System(odd+:cos,erora%cs) Unit heater(commorcat use) <br /> Exhallst Fan((oddentirll W C(arlrrliac;al use) Water IleWer(2ns or electric) <br /> Fxhottst Hood(rasidnntlal ovor slovo) WoodlPoitol Slovu or Insod <br /> exhaust Hood Type I*** Other(I tsl Typo) <br /> IFxhaust Hood type 11*** Olhor(List typo) <br /> I urnace(residential) Other(List Type):__ <br /> * For commercial gas fireplacos,plonso attach plans and manulac.toror'e inf,tatlalion manual. <br /> ** Under Oosc0plloa of Wn,k,please Mrlydu Typo of 1?qu+pment,nuulel fi's.ad do!ailed des6litiun of tuxk,and lha luttalioll of the equ preen. <br /> *** ypo 1 hood and Type 11 Imods shall lin on a stand atom Mochmlir al Permit applicnl'on and requires plan roview.Please submit ilio requlred documents as <br /> Tescribed in Iho associated Checklists online at evarothm.11oviluumits undor Iho Charklisls R Huadouts tab. <br /> ACKNOV/i(:UGFLfFNL•i h:rnr tvvimved Rls aplaration nrxl contain tho infaawbon contafnr:d horoin is two and corroct.V7ork dono pursuant to this panel Hurst comp/tvdh <br /> current todoral,stalo,aW kwallavi Iho gran6rxi of o porrnl vr,y vnlhurinrs appnlvvd truck orxl no doviations thcrotrom.VoviaWns trust first bo owhoritod in vniGcg from tho <br /> 17m,'Ming 0171c17l bototu boing null;owizod undorony clrcurnstanco.f am Iho omrrt,ar I:Nn nbUxmitad by tho alt'nor off lis iuoporty to podoen the work tot whLfr upp!'eath:n b;nrsdu, <br /> and l enntpl/InlhTito Stalo Corrbaclews 1 my 11127IiCW mut 2961MA VIAL. <br /> (".ly of hV01olt OHwidl tlsu Only <br /> � PCF2h11T k <br /> - � - z3 b2 - 6)6 � <br /> Owner/Authorized Argent SlUnaluro Dato (Rovised 2111002 1) <br />