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4 <br />l� <br />EVERETT <br />MECHANICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plan to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />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 e ja5 Al XPo4r PARCEL #: <br />CRYiSTATE ZIP 946 <br />SUITE/UNIT M 1W FLOOR M % ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): P151ZLL'r 04 <br />CONTACT INFORMATION <br />OWNER NAME: Md aw 5 !V 1`�aCr4- p <br />OWNER MAILING ADDRESS: STREET L% lf, 4ffiOIi Pp tit - <br />CITY ev"t--r/ STATE ZIP V <br />OWNER PHON � (P+ <br />OWNER EMAIL: h7TPS'��WrdirJ.1�IJ�1L�S /t��SA"zb <br />CONTRACTOR COMPANY NAME: AjqWA)C . <br />WA STATE CONTRACTOR LICENSE #(REQUIRED .? O'f Q <br />/ <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET I �1 <br />) Q J <br />r- M �� ta4 . STATE k4l ZIP <br />CONTRACTOR PHONE: 5 &j —2,333 <br />1 CONTRACTOR EMAIL: a n heed. am <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 5j7& -?� <br />CONTACT EMAIL: aJanly h0TeC,9.&M <br />MECHANICAL PERMIT INFORMATION <br />VALUATION OF WORK: $ <br />ASSOCIATED PERMIT # (if applicable): N <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 />UAn�its: Str5uct�ure <br />❑ADU ❑M1 ulti-Familys- Wc'o�mmZere�rciiiTal Acces5s1or�y <br />BUILDINGTYPE: ISFR ❑Townho�u�s�ea <br />TIONEEORK: ��A%�KK30vOI"a, t�i <br />r# fQ❑l� <br />{�❑Duplex <br />� <br />� <br />�X(� �•t�iJ76 l <br />MECHANICAL PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />A/C Unit (attach plan with location of outdoor unit) <br />Gas Piping - List # of outlets in fixture count <br />Air Handling Unit ** <br />Gas Appliance ** <br />Boiler (most require backflow prevention) ** <br />Gas Fireplace, Insert, and/or Log (* for commercial bldgs) <br />Commercial Refrigeration (walk-in coolers, VRF, VRV, etc.) <br />Gas - Other (List Type):_ ** <br />Commercial Ventilation (corridors, stairwell, pressurization, etc.) <br />Heat Pump (attach plan with location of outdoor unit) <br />Compressors/Generators (building permit may be required) ** <br />Heat Pump Ductless (attach plan with location of outdoor unit) <br />Clothes Dryer Exhaust <br />Hydronic Piping <br />Duct System (additions, alterations) <br />Unit heater (commercial use) <br />Exhaust Fan (residential or commercial use) <br />Water Heater (gas or electric) <br />Exhaust Hood (residential over stove) <br />Wood/Pellet Stove or Insert <br />Exhaust Hood Type I *** <br />Other (List Type): <br />Exhaust Hood Type II *** <br />Other (List Type): <br />Furnace (residential) <br />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/perm its under the Checklists & Handouts tab. <br />ACKNOWLEDGEMENT.., I have reviewed this application and confirm the information contained nerem is true and correct. Work done pursuant io uns perrnn muse cumpiy wnn <br />current federal, state, and local law. The granting of a rmit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official befo b eng authoriz unde dr ci , msiance. 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 cam ith t e Sta a Co a o Law 8.2 and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />7 2'2' 2S <br />Owner/ th rized Agent Signature Date (Revised 412112022) <br />