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MF"HANICAL PERMIT APPLIr ' ION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 11 w I C PARCEL#: CITY STATE WA zip 2 L} SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION:. TENANTIBUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: TtEf L 4 OWNER MAILING ADDRESS: STREET L ( Fjv1jjr AV I, CITY t l: STATE /� zip tr_ OWNER PHONE: 'Z �� 3 S - L^ OWNER EMAIL: C Gtt ` Z• c'!'� CONTRACTOR COMPANY NAME: r S u 4 ionS LL-G WA STATE CONTRACTOR LICENSE#(REQUIRED): &D .3 Q 5 rS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREE- 910•] � ' /,' 4✓L E CITY Q I-V cn STATE WA LIP 2 CONTRACTOR PHONE: Lj 2$-' 23 SJCS 10 CONTRACTOR EMAIL: -it PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: rTz ,n CONTACT PHONE: 1—T j sl - J r� CONTACT EMAIL: MECHANICAL PERMIT INFORMATION VALUATION OF WORK:$ t:Ce? CG 1ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work.whether actually paa or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESC IPTION OF WORK:�-:✓c r c ids.� �`I a e, .-t e-v N-lJ t �� +� �`�tn W 2" I r1S Gl� rsc� � +tchn, c�gn . 'ThA1' n«d �r�I �r dK��;ny ar� d Vtn �.i wnd arts 61eel-Ie fie ��0►✓ a '1 i n u� u ion Nor d I ��' 1� J. tan incl ten. 9,", 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 outcoor unit) Gas Piping-List#of outlets in fixture count Air Handling Unit** Gas Appliance** Boiler(most require backflow prevention)** Gas Fireplace,Insert,andlor Log(*for commercial bldgs) Commercial Refrigeration lwalk-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 may be required)** Heat Pump Ductless(attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronic Piping Duct System(additions.alterations) Unit heater(commercial use) 17, Exhaust Fan(residential or commercial use) Water Heater(gas or electric) Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert Exhaust Hood Type I*** Other(List Type): Exhaust Hood Type II*** Other(List Type) Fumace(residential) Other(List Type): ___ * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. ** Under Descnplion of Work,please include Type of Eauipment.model#'s,ad detailed description of work,and the location of the equipment. Type I hood and Type 11 hoods shall be on a stand alone klechanica!Penn,:applicatior•and requires plan review. Please submit the required documents as 'k** described in the associated Checklists online at everettwa.gov/permits under the Checklists&Handouts tab. ACKNOWLEDGEMENT:I have reviewed this applicatior and confirm the Information,contained herein Is true and correct. Work done pursuant to this permit must comply with 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 wnting from the 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 and I comply with the State Contractors Law 18 27 RCW and 296.200A WAC. City of Everett Official Use Only 7 .3 PERMIT# V ^ Owner/Authorized A ent Signature f bate (Revised 412112022)