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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)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET ' PARCEL#: <br /> crry STATE �} ZIP <br /> SUITE/UNIT#: I V FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): /�}\ ^ x , �� L -(i <br /> CONTACT INFORMATION <br /> OWNER NAME:Av-(,,)-,v-\ <br /> OWNER MAILING ADDRESS: STREET VAU•-A \JtA•- ulY AVM <br /> CITY Cv Q�� STATE V/ ZIP <br /> Aq <br /> OWNER PHONE:L3 ZS - C\Z-� .-'-`1&\` OWNER EMAIL: cut-\ <br /> CONTRACTOR COMPANY NAME: LG✓\�Y0 \ vw��jl LL(� <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). 77 Z <br /> CONTRACTOR ADDRESS: STREET <br /> CnY t-4- STATE )At- ZIP �S r <br /> CONTRACTOR PHONE: L1ZS - S\Z-0\L40,5 1CONTRACTOR EMAIL: -Ao jL,Avu, <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LA-L�- \— <br /> CONTACT EMAIL: /r%U^�ry w`ti I CUrCCt,T .t-C <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: 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 /> BUILDINGTYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Wcommercial ❑Accessory 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 /> (Qty) PY) <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 backfiow 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 maybe 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 manufacturers 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 11 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 wif,fng 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 16.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />