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ME HANICAL PERMIT APPLI(, JION <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 222 W. Marine View Dr PARCEL#: 0014050& 2951321 <br /> CITY Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): Cadman <br /> CONTACT INFORMATION <br /> OWNER NAME: Justin Lundgren <br /> OWNER MAILING ADDRESS: STREET PO Box 97038 <br /> clTr Everett STATE WA zip 98201 <br /> OWNER PHONE: 425-766-7237 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: Evergreen State Heat&AC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): EVERGSS0220T I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 007955 <br /> CONTRACTOR ADDRESS: STREET 8431 Maltby Rd <br /> crtY Snohomish STATE zIp 98296 <br /> CONTRACTOR PHONE: 425-252-31 14 1CONTRACTOR EMAIL:ashley@essmwa.COm <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-252-3114 <br /> Ashley G i h fstrom CONTACT EMAIL:ashley@essmwa.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK:$ 11,1$2.00 AS 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 /> Install 2 zone ductless heat pump <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF 1iVORK) <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)** 1 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 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 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 writing from the <br /> Building Official before being authorized under any circumstance.1 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 286.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 21812021) <br /> l 1Z <br />