1717 13TH ST FLOOR 2 EVERETT CLINIC 2022-05-06

ME•ANICAL PERMIT APPLICSION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application &plan to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425.257.8810 I (E)everetteps@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1717 13th St PARCEL#: 00409423000100 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: BASEMENT ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: PROVIDENCE HEALTH & SERVICES WASHINGTON OWNER MAILING ADDRESS: STREET 1801 LIND AVE SW#9016 cm), RENTON STATE WA ZIP 98057 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:MACDONAL MILLER FACILITY SOLUTIONS WA STATE CONTRACTOR LICENSE#(REQUIRED):MACDOFS808OS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 040665 CONTRACTOR ADDRESS: STREET7717 DETROIT AVE SW c,TY SEATTLE STATE WA ZIP 98106 CONTRACTOR PHONE:2068674133 CONTRACTOR EMAIL:Permits@macmiller.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2068674133 AMANDA MOORE CONTACT EMAIL:permits@macmiller.com MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $25000 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: RCommercial ❑Accessory Structure DESCRIPTION OF WORK: Demo and Replace(1)Air Compressor and(1)Air Dryer and add(1) receiver tank. Demo and replace(1)VAV terminal unit. Furnish and install (1)fractional HP inline exhaust fan and ducting from mechanical space to outside. Shuffle(8)diffusers in existing Tomography space. MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (Qty) NC Unit(attach plan with location of outdoor unit) Gas Piping-List#of outlets in fixture count Air Handling Unit** Gas Appliance** Boiler(most require backflow prevention)** Gas Fireplace,Insert, and/or Log(*for commercial bldgs) Commercial Refrigeration(Walk-in coolers,VRF,VRV,etc.) Gas-Other(List Type): ** Commercial Ventilation(corridors,stairwell,pressurization,etc.) Heat Pump(attach plan with location of outdoor unit) 1 Compressors/Generators(building permit may be required)** Heat Pump Ductless(attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronic Piping Duct System(additions,alterations) Unit heater(commercial use) 1 Exhaust Fan(residential or commercial use) Water Heater(gas or electric) Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert Exhaust Hood Type I *** 1 Other(List Type):VAV TERMINAL Exhaust Hood Type II *** 1 Other(List Type):AIR DRYER Furnace(residential) 1 Other(List Type): RFCFIVFR TANK * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. ** Under Description of Work,please include Type of Equipment, model#'s,ad detailed description of work,and the location of the equipment. 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 *** described in the associated Checklists online at everettwa.gov/permits under the Checklists&Handouts tab. 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 1 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. Digitally signed by Amanda Moore City of Everett Official Use Only ON:C=US,E=amanda.moore@amacmiller.com, PERMIT# A I Amanda Moore O=MacDonald Miller Facility Solutions,OU=Permit A /y94) Specialist,CN=Amanda Moore 116 UI ^ ,) 5 pvj Date:2021.09.16 08:37:25-07'00' 9/1 6/2021 Owner/Authorized Agent Signature Date (Revised 2/8/2021)