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Nom lizi MECI- VICAL PERMIT APPLICAT•N CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET Sb l% f i&OA AVt PARCEL#: 00g5 1 SOO 9-06 R-b 1 CITY &Pelt,* STATE VVI 1 ZIP Rga'O� SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: - .c f€. . + .Ai(Cn Pc-;ct. OWNER MAILING ADDRESS: STREET scA,A`Z qs Qro3e.c k RAS re-CS CITY STATE ZIP OWNER PHONE: Lc - q 1 - 11() OWNER EMAIL: (10 4(A/42, NA& I/‘.a';"MCA;I . cc CONTRACTOR COMPANY NAME: St-lot0+;DA e, k-\owi\.t. ZZAOV'Q4i6Nf.. WA STATE CONTRACTOR LICENSE#(REQUIRED):%bWTH 2$o(tINF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G a-d y 1 CONTRACTOR ADDRESS: STREET 14 1 ICJ l�eASt,lc S4-. Sf- I OS CITY AA.Onfo-e STATE ZIP -Lg a- CONTRACTOR PHONE: Li j- . -1,(z)-9-()Lk et CONTRACTOR EMAIL:RuSScIi ,SYIoW+'f 1t kasiv.e f A0V0t4iOd1.•COWL PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR MOTHER(Please Specify) D$S;c�1n�P/t( � CONTACT NAME: _ CONTACT PHONE: 92-S-- `Ji( RI qD -e1A/ta. hf CONTACT EMAIL: (.GK4� 4.4..c k_kes jru c-MA pa4 . Cowl MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $ 5676Der 57 CDC ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ' SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: II Jv'+e r i o f rOYVI O(J�` MIOA CCL"h oti R-ct, Ps0A.4- 'e N- ocoLt.t jam.UA- . MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (Qty) A/C Unit(attach plan with location of outdoor unit) Gas Piping-List#of outlets in fixture count Air Handling Unit** Gas Appliance** Boiler(most require backflow prevention)** Gas Fireplace, Insert,and/or Log(*for commercial bldgs) Commercial Refrigeration(Walk-in coolers,VRF,VRV,etc.) Gas-Other(List Type): ** Commercial Ventilation(corridors,stairwell,pressurization,etc.) Heat Pump(attach plan with location of outdoor unit) Compressors/Generators(building permit may be required)** Heat Pump Ductless(attach plan with location of outdoor unit) 1 Clothes Dryer Exhaust Hydronic Piping Duct System(additions,alterations) Unit heater(commercial use) ?.,. Exhaust Fan(residential or commercial use) I, Water Heater(gas or electric) Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert Exhaust Hood Type I *** Other(List Type): 4 Exhaust Hood Type II *** Other(List Type): 'Furnace(residential) Other(List Type): * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. ** Under Description of Work,please include Type of Equipment,model#'s,ad detailed description of work,and the location of the equipment. 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 *** described in the associated Checklists online at everettwa.gov/permits under the Checklists&Handouts tab. 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 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 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, and I comply with the State Contra ors Law 1 .27 RCW and 296.200A WAC. 2,....,_ City of Everett Official Use Only / PERMIT# (Dl /P- 9 (Revised 4/21/202 i3 o -1 v Owner/Authorized Age Signature )