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• <br /> MECHANICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVE R E T T 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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please). PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET S PARCEL#: <br /> CITY ner 1- STATE W ZIP -/ <br /> SUITE/UNIT#: FLOOR#: / ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME: / /, -jJ ( M7Z,U T1 <br /> OWNER MAILING ADDRESS: STREET � "gei`: ( T C4 <br /> CITY V t( STATE ZIP <br /> OWNER PHONE: S7 l rU /Ot OWNER EMAIL: /btu k3Z C u i • C a - <br /> CONTRACTOR COMPANY NAME: 3 G j <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): /14 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):.k..I — <br /> CONTRACTOR ADDRESS: STREET /fO/14t'`o(JAJ/72_ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 5' "` CONTRACTOR EMAIL: l2ba,VK' 3 z L I C<Je,.t <br /> PRIMARY CONTACT: WNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: mite: <br /> CONTACT EMAIL: st ��r� <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$ feErn ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair ma t 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 /> /Avg r <br /> MECHANICAL PERMIT FIXTURE COUNT(SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (QtY) (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*** 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 <br /> Everett Official Use Only <br /> ,01 <br /> 4/0 ZZ PERMIT IP (/v l O nl v5 <br /> Owner/Author' d gent Signature Date (Revised 2/8/2021) <br />