2930 MAPLE ST KAISER PERMANENTE 2019-11-06

PERMIT APPLICATIO ■ BUILDINCIAIECHANICAL/ PLUMBING/SIGIs* RINKLER/DEMOLITION /� CITY OF EVERETT PERMIT SERVICES 1� 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.govlpermits (Blue or Black Ink only l ease) PROJECT SITE INFORMATII ti.. PROJECT SITE ADDRESS: 2930 MAPLE ST, EVERETT, WA 98201 PROPERTY TAX#: 00439069505800 LEGAL for new construction: Short Plat/subdivision SEE ATTACHMENT Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: KASISER PERMANENTE TENANT NAME(If Commercial): KP EVERETT REBRAND OWNER MAILING ADDRESS: STREET 12501 EAST MARGINAL WAY SOUTH CITY TUKWILA STATE WA ZIP 98201 OWNER PHONE: N/A OWNER EMAIL: N/A CONTRACTOR NAME: MACDONALD MILLER FACILITY SOLUTIONS CONTRACTOR ADDRESS: STREET 7717 DETROIT AVE SW cim' SEATTLE STATE WA zip 98106 CONTRACTOR PHONE: (206)768-4062 CONTRACTOR EMAIL: permits@macmiller.com CONTRACTOR LICENSE#(REQUIRED): MACDOFS980RU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 040665 PRIMARY CONTACT: 0 OWNER w CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (206) 768-4062 AMMONE BEMBRY CONTACT EMAIL: permits@macmiller.com BUILDING PERMIT APPLICATION Existing Use of Building:MEDICAL CENTER Contract Price of Work:$ 10,500 Proposed Use of Building: MEDICAL CENTER Heat Source: ID Gas ❑Electric El Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial CI Industrial Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Install(1)new sink in new location,(1)water supply,backflow preventer and drain for an espresso machine,(1)new drinking fountain in new location,(1)new drinking fountain in existing location. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING.PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures _Fixtures A/C—Air Handling Units Heat Pump Toilet _ 1 Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) 2 Drinking Fountain Water Heater Refrigeration Shower _ Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: 3 WATER WASTE DRAINS SPRINKLER(SUPPRESSION SYSTEM 1 WATER SUPPLY PIPING 1/2" Chemical or Water I No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 12/04/2018 PEI15#1. co2- Owner/Authorized Agent Signature Date (Revised 9/23/2016)