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PERMIT APPLICATIO <br /> 4.77. BUILDINCECHANICAL / PLUMBING / SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: IDROPERTY TAX#: 00438524701100 <br /> 1330 Rockefeller RD Everett,WA 98201 <br /> LEGAL for new construction: Short Plat/subdivision_ Lot No. (attach copy of long legal description) See attached <br /> CONTACT INFORMATION <br /> OWNER NAME: Providence Health Center TENANT NAME(If Commercial): 5A-Me. A-S 0+ �tt€,r <br /> OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW#9016 <br /> CITY Renton STATE WA ZIP 98057 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: MacDonald Miller <br /> CONTRACTOR ADDRESS: STREET 7717 Detroit Ave SW <br /> CITY Seattle STATE WA ZIP 98106 <br /> CONTRACTOR PHONE: (206) 905-3748 CONTRACTOR EMAIL: aprll.hOUSe@macmiller.com <br /> CONTRACTOR LICENSE#(REQUIRED): MACDOFS980RU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 040665 <br /> PRIMARY CONTACT: El OWNER E CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: alb )(®SS— 44-2SC( <br /> 6/eDi' e ra`netm CONTACT EMAIL: <br /> y 'wo�zZe •G�7 tu4 e M„C ley.0 ti✓►� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: MEDICAL CENTER Contract Price of Work: $ izi,200.00 <br /> Proposed Use of Building: MEDICAL CENTER Heat Source: ❑Gas Il Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ©Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair IIJT.l. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> Install (28)Sinks, (2)eyewash station with valves, (1) Insta Hot, (6)floor drains, lays and water closets and (2)refer box connections. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _x Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump _6 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 6 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower 6 Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: VAV Clothes Washer _Medical Gas <br /> Range Hood Smoke-EYE—Ter' Water Heater _ 2 Other: Eyewash with valves _ <br /> Exhaust Fan Grilles _ 28 Sink(Service/Bar/Mop/etc.) 2 Other: Refer Box Connections _ <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <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 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / / City of Everett Official Use Only <br /> e S ii, 01,E <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) !I? <br />