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MEr-'ANICAL PERMIT APPLIC"''ION
<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 1(W)everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET Ngal n V'v. PARCEL#: 2 e0 (50]00 :30 7 DOG'
<br /> CITY z-vei eik'c STATE IA A- ZIP 7/J 3
<br /> SUITE/UNIT#: °�\f1e. tis FLOOR#: ADDITIONAL LOCATION INFORMATION:
<br /> TENANT/BUSINESS NAME(if non-residential): 1)01,v' kul
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 1'6wl` COY r, 6 ON,frivilex LL-(--
<br /> OWNER MAILING ADDRESS: STREET liWct
<br /> CITY c)eAV,V STATE tAdA ZIP q
<br /> OWNER PHONE: -Vic) - ' j� t���r)i OWNER EMAIL:
<br /> CONTRACTOR COMPANY NAME: Sodvq,, (k- v i p\c,
<br /> WA STATE CONTRACTOR LICENSE# REQUIREDD:i�� ']%5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): f
<br /> CONTRACTOR ADDRESS: STREET Sc51 1 �, S� CT .A
<br /> cry VI.kyiC,X,UP STATE WA ZIP ( i3 l 5
<br /> CONTRACTOR PHONE: 1 G()• A6', '7 T f*i CONTRACTOR EMAIL: +�Ct,V\ 6t cOUVrAVYCL'hAt y'�aLt
<br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ElOTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: � `�h ti s - 71`1L,
<br /> \V\'- (\, CONTACT EMAIL: 9etAAct6.y se,,, (/Ia,oL'm-wV4
<br /> MECHANICAL PIERMIT INFORMATION
<br /> p 20
<br /> VALUATION OF WORK: $ �Sdr /�0 °� ASSOCIATED PERMIT#(if applicable): 3 (
<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: r,MCommercial ❑Accessory Structure
<br /> DESCRIPTION OF WORK: ''1,) v)61,l[.1t,LSt r//(vl5 ((Ctlyvldw veil{(\&tltvu; W\mil �,',i,dy�`��t�s / c -j( v-
<br /> `�i(�Ssuv�'L(:ltl�vt jySk?,VAS �(NYkPNS 1A.1\e 11/4) 0 1 RUN- ►IAA C SP tl-jwXteak L(i16fNikvr
<br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK)
<br /> Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures
<br /> (Qty') (Qt1)
<br /> A/C 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 Contractor Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> � � - Z2 — 00
<br /> Owner/Authorized A nt Signature Date (Revised 4/21/2022)
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