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<br /> umi 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 /> CONTACT INFORMATION: (P)425 257,8810 I(E)everetteps@everettwa.gov I(W)everettwa.govipermits
<br /> VYASHINGTON
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: siREET bitc, ik....V."0„,...,%„Ai 'Mt— PARCEL#:
<br /> crty 6,..,,,....,,„„ STATE ifrzit\ ZAP' CiS'1,:..1
<br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION:
<br /> TENANT/BUSINESS NAME(if non-residential):
<br /> CONTACT INFORMATION ..
<br /> OWNER NAME: Cif 9 ct.),24-b) \,,n,c4.1/4-,—„k-;, L.Lc --* apv-meGtro --
<br /> OWNER MAILING A.DDRESS: STREET 24,.. c i) ^6\-.-- t- 1,-/e- Ly. c (5
<br /> CITY Le4-e..* STATE pkoln ZIP
<br /> OWNER PHONE: '' AO KA "1-.45-I,\ OWNER EMAIL: .t..,,e,--,;)p....Nrs,e-t,..g,..> e ri,,, .:.\
<br /> CONTRACTOR COMPANY NAME;
<br /> s44.3;
<br /> WA STATE CONTRACTOR UCENSE#(REQUIRED): 4
<br /> L-n,OF EVERETT BUSINESS LICENSE#(REQUI ): 2.(:)2,
<br /> CONTRACTOR ADDRESS: STREET N‘ 3..\
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<br /> crry vbso,„,,,..,,,,,,%,e STATE VA. ZIP ti 2'IL,
<br /> CONTRACTOR PHONE: "\'L,--,) 2'5\ c- C)‘ CONTRACTUR EMAIL:
<br /> PRIMARY CONTACT: L;OWNER E CONTRACTOR CI OTHER(Please specify)_ '
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> MECHANICAL. PERMIT INFORMATION
<br /> -.It.,
<br /> VALUATION OF WORK:cir.mtCCOtevriter5rarr5w---D [ASSOCIATED PERMIT#(if applicable):
<br /> -*Ialualion shall include the prevaiiin a or,materials,and equipment needed to complete the work,whether actually paid or not.)
<br /> BUILDING TYPE: OSPIR OTownhouse EDuplex EADU EIMulti-Family-#Units: , [I]Commercial LiAccessory Structure
<br /> DESCRIPTION OF WORK:
<br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK)
<br /> Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures
<br /> (WY) (QtY)
<br /> A/C Unit(attach plan with location of outdoor unit) Gas Piping-List#of outlets in fixture count
<br /> ,Air Handling Unit** ‘e Gas Appliance**
<br /> I 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(corndors,stawwell pressunzatlon,etc.) i 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 /> 1 Clothes Dryer Exhaust ,Hydronic Piping
<br /> Duct System(additons.alterations) Unit heater(commercial use)
<br /> 2_dr Exhaust Fan(residential or commercial use) 1 Water Heater(gas or electric)
<br /> L 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 /> i Furnace(residential) _Other/List TyFey
<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 /> ***
<br /> described in the associated Checklists online at everettwa.goyfriermits 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 focal 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 /> arid!comply with the Sfatefp1rltractors Law 18.27 RCW and 298.200A WAG
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<br /> - — ' _.... -) PERMIT# City of Everett Official Use Only
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<br /> OwnerlAahorized Agent Signature 'Date (Revised 2/872021)
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