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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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: _STREET r6 0 75r- HJ1 u/6-yPARCEL#: <br /> �IILtr'G I T— STATE lil/ ZIP —{ 1S �0 <br /> SUITE/UNIT#: - FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSIN (if non-residential): r <br /> CONTACT INFORMATION <br /> OWNER NAME: L 4- l�r,r7"I V- 7 f ld G C-- <br /> OWNER MAILING ADDRESS: STREET ti L*"i- <br /> CITY 5 w-c/ STATE G- "L- ZIPS <br /> OWNER PHONE: - 3 d `�. Z OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: 4- /�G i,/7ty� Ct1 S f y(r-C. t D <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):T P LO N G SjI OF EVERETT BUSINESS LICENSE#(REQUIR ): D <br /> CONTRACTOR ADDRESS: STREET e- �� f IV. C e-'^TV, <br /> CITY l\!i� STATE A- ZIP 3 <br /> CONTRACTOR PHONE: 206- 7 y"" z CONTRACTOR EMAIL: ��t/`✓-y 0-7r ti vGLL- (• GG <br /> PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> tit if CONTACT EMAIL: 5C' -c-- <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$ QQU - 6 ASSOCIATED PERMIT#(if applicable): <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 ❑Mu ti-Family-# ni ommercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: tD y C_IGvtti <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORD <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qtv) lacy) <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): n L o <br /> Exhaust Hood Type II*** Other(List Type): <br /> Furnace(residential) I Other(List Type): 1 C-- <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.1 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# ow c_ <br /> OwnerlAuthorize g t Signature Date (Revised 21812021) <br />