3927 RUCKER AVE BASE FILE 2020-01-30

PERMIT APPLICATIGt BUILDINV I MECHANICAL / PLUMBING / SIGN, -PRINKLER / DEMOLITION � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 l (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 3927 Rucker Ave PROPERTY TAX#: 2910495 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: The Everett Clinic TENANT NAME(If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET 3901 Hoyt Ave cin Everett STATE WA ZIP 98201 OWNER PHONE: 425-258-3900 OWNER EMAIL: MKimberlin@everettclinic.com CONTRACTOR NAME University Mechanical Contractors CONTRACTOR ADDRESS: STREET 11611 49th PI West crry Mukilteo STATE WA ZIP 98275 CONTRACTOR PHONE: 425-359-5592 CONTRACTOR EMAIL: clermusik@umci.com CONTRACTOR LICENSE#(REQUIRED): UNIVMC*343N9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 006726 PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-359-5592 Chris Lermusik CONTACT EMAIL: clermusik@umci.com BUILDING PERMIT APPLICATION Existing Use of Building: Medical Contract Price of Work: $ 50,000 Proposed Use of Building: Medical Heat Source: ❑Gas OElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: VCommercial ❑Industrial Type of Project: El New EAddition 12Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use DESCRIPTION OF WORK: Replace two existing MRI Chillers with like size 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 Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) 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 7 Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: SPRINKLER/ SUPPRESSION SYSTEM Chemical or Water 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 corn y with the e Contractors Law 18.27 RCW and 296.200A WAC. //://? f ( ( City of Everett Official Use Only PERMIT `0 V�f Owner/Authorized Age)it Signature \g(Revised 9/23/2016) 1 / -