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MECF NICAL PERMIT APPLICAr- 7)N <br /> E CITY OF EVERETT PERMIT SERVICES <br /> R 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 4526 Federal Ave PARCEL* <br /> Cry Everett STATE WA ZIP 98203 <br /> SUITElUN[T M FLOOR#: Rooftop ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):Compass Health <br /> CONTACT INFORMATION <br /> OWNER NAME: Compass Health <br /> OWNER MAILING ADDRESS: STREET 4526 Federal Ave <br /> CITY Everett STATE WA Zip 98203 <br /> OWNER PHONE:(425)349-8353 OWNER EMAIL:lisa.swisher@compassh.org <br /> CONTRACTOR COMPANY NAME:Hermanson Company <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):HERMACLO05BJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 37262 <br /> CONTRACTOR ADDRESS: STREET 1221 2nd Ave N <br /> CITY Kent STATE Wa ZIP 98032 <br /> CONTRACTOR PHONE:(206)638-6961 CONTRACTOR EMAIL:kwilliams@hermanson.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-638-6961 <br /> Kennedy W i l l i a m s CONTACT EMAIL:kwilliams�-@hermanson.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$34,000,00 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 ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> Like for like replacement of (5) rooftop package units. <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <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)ir* 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 is is dF 5 Other(List Type):Roonao naoka duniU <br /> Exhaust Hood Type ll Other(List Type): <br /> Furnace(residential) Other(List Type): <br /> * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. <br /> *it 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 If 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 Officlal 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 RC and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ....- PERMIT# A 2_ 7-O — 0 q <br /> Kennedy Williams _ .,..,w....,..a.,.....,�....,,P�A, 3128122 �14 <br /> Owner/Authorized Agent Signature Date Date (Revised 21812021) V <br /> Z <br /> .................... <br />