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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 j(E)PermitServices@everettwa.gov 1(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET8125 Everqreen Way PARCEL#: 28050700302000 <br /> CITY Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):DISCOUnt Tire <br /> CONTACT INFORMATION <br /> OWNER NAME: HALLE PROPERTIES LLC <br /> OWNER MAILING ADDRESS: STREET 20225 N SCOTTSDALE RD <br /> CITY Scottsdale STATE AZ zip 85255 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:TBD <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR m OTHER(Please Specify)Agent for Tenant <br /> CONTACT NAME: CONTACT PHONE:608-407-9082 <br /> Erika Hultman CONTACT EMAIL:erika@permit.com <br /> ME° ANIC L PERMIT INFORMATION <br /> VALUATION OF WORK $ vC A SSOCIATED PERMIT#(if applicable): <br /> (Valuation shall iF.Clude the prev iling fair market value of all labor,materars,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse CtDuplex ❑ADU ❑Multi-Family-#Units: MCommercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> Updates to existing mechanical system <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)** 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) 1 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/perp ecost Handouts tab:. <br /> ACKNOWLEDGEMENT:I have reviewed this application and confinn the informati t r e t orrest Wo ne pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes appro o d n e 9-the rom.Devi4ti s must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner, r authorized by the owner of this pro I 0 perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. APR 2 <br /> 2 City of Everett Official Use Only <br /> �y PERMIT <br /> j�G�i `�-17-2glTY OF EVtI NETT �2�0 <br /> Owner/Authorized Agent Signature Date ^t-11TIIi 6erv(4n45sjd4/21/2022) <br />