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MECHANICAL PERMIT APPLICATION <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 535 View Ridge Drive PARCEL#: 004647-000-062-01 <br /> Ciro Everett STATE WA zip 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME (if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME: J&S Development LLC <br /> OWNER MAILING ADDRESS: STREET 22621 57th Ave SE <br /> CITY Bothell STATE WA zip 98021 <br /> OWNER PHONE:425-870-8922 OWNER EMAIL:bstrootman@msn.com <br /> CONTRACTOR COMPANY NAME:Forbes Mechanical L i i,&)) G IGCNSc <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):FORBEM''886P5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET6915 123RD Ave NE <br /> cITY Lake Stevens STATE WA ZIP 98258 <br /> CONTRACTOR PHONE:425-446-1053 CONTRACTOR EMAIL:forbesmechanical@gmail.com <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Civil Eng-Project PM <br /> CONTACT NAME: CONTACT PHONE:425-773-9567 <br /> Bob Nehring, PE, Sound Design Eng <br /> CONTACT EMAIL:bob.sdeng@gmail.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $42000 ASSOCIATED PERMIT#(if applicable): 307 ' U <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 /> Mechanical work for SFR model 4335 w/ gas range and dryer <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> MIA (Qty) <br /> I A/C Unit(attach plan with location of outdoor unit) 6 Gas Piping-List#of outlets in fixture count <br /> Air Handling Unit** 2 Gas Appliance** <br /> Boiler(most require backilow prevention)** 3 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.) r 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 /> t 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 /> I 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 /> 1 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# <br /> 6/26/23 A '3_1111 <br /> OwnertAu orized Agent Signature Date (Revised 412112022) <br />