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MECHANICAL PERMIT APPLiCATIU,.4 CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. wnsHINGTON CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@evereltwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET •�Iv Ak-jCt vh PARCEL,#`p(205019Ul9UU IC(00 CiTY veC Vy fud- STATE r ZIP SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: &rn 6%nd Itfn Hvebr+etr OWNER MAILING ADDRESS: STREET 10 Allj0C oK cny 15ver STATE 4f A ZIP OWNER PHONE: 461$ OWN EREMAIL:10VIJGronGr* soutlf.C&WK CONTRACTOR COMPANY NAME: `.�► d N 41.0 WA STATE CONTRACTOR LICENSE#(REQUIRED); 1�> t✓J5 Vi 07- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 138 63 ?5'1 C4'AI v,,- N E CITY D o votll STATE v A A ZIP q SC4 1 CONTRACTOR PHONE: 47-5 `Z�3 ' 15L\ CONTRACTOR EMAIL: wla�,�t 6 Ccv� vt�lAi1.CCl+�'1 PRIMARY CONTACT: ❑OWNER g CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: 7, / ` CONTACT PHONE: N ZS _-L — l5�jfj P�lex C1n�rG� CONTACT EMAIL: �„hh A!B 6pp w.a:l•u9wr MECHANICAL PERMIT INFORMATION VALUATION OF WORK:$ 1 oo ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevaHing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: WSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: L01U►1drI re l0Cc.};a✓l. \iev%A- drye otnd tXl►cwSk A✓1 Yo eK-fCi70r 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 backftow 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 maybe required)** Heat Pump Ductless(attach plan with location of outdoor unit) ( Clothes Dryer Exhaust Hydronic Piping Duct System(additions,alterations) Unit heater(commercial use) 1 Exhaust Fan(residential or commercial use) Water Heater(gas or electric) Exhaust Hood(residential over stove) WoodlPellet Stove or Insert Exhaust Hood Type I*** Other(List Type): Exhaust Hood Type II*** Other(List Type): Furnace(residential) Other(List Type): * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. VV ** Under Description of Work,please include Type of Equipment,model Vs,ad detailed description of work,and th on of aWrit. Type I hood and Type 11 hoods shall be on a stand alone Mechanical Permit application and requires plan reviev.. ase submit the required documen *** 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 doJ pUsuanto this pe It m s omply w current federal,state,and local law.The granting of a permit only authorizes approved Bork 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 1 am authorized by the owner of this property to pereertrr�fB yf v@or 1VlEaR1&FnTs made, and i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City ofR,,%ha$?,r&�ce s 77IT7 10-(I - ZyZ3 Owner/Authorized Agent Signature Date (Revised 21812021)