1700 13TH ST 1ST FLOOR 2022-05-16

grr PERMIT APPLICATION. BUILDING / MECHANICAL / PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1700 13TH ST, EVERETT, WA 98201 PROPERTY TAX#: 00438524702102 LEGAL for new construction: Short Plat/subdivision SEE ATTACHMENT Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: PROVIDENCE HEALTH&SERVICES WASHINGTON TENANT NAME(If Commercial): PRMCE CT Room Renovation OWNER MAILING ADDRESS: STREET 1801 LIND AVE SW#9016 crry RENTON STATE WA ZIP 98057 OWNER PHONE: N/A OWNER EMAIL: N/A CONTRACTOR NAME: MACDONALD MILLER FACILITY SOLUTIONS CONTRACTOR ADDRESS: STREET 7717 DETROIT AVE SW CITY 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 p'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:$ 12000.00 Proposed Use of Building: MEDICAL CENTER Heat Source: OGas EIElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial Type of Project: ONew ❑Addition 2Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use DESCRIPTION OF WORK: INSTALL NEW VAV, DUCTING, MED GAS OUTLETS AND SINK, PER PLAN. ASSOCIATED BUILDING PERMIT#(if applicable): TBD MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn if Alteration _Repair Type of Project: New Addn Alteration _Repair #of #of List of Fixtures #of List of Fixtures List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC—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 1 Ducting Dishwasher Roof Drains Clothes Dryer Hookups 1 Other: VAV Clothes Washer 6 Medical Gas Range Hood Water Heater Other: Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water J 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 PERMIT#• )(1003—a) Owner/Authorized Agent Signature Date (Revised3/2016)