3927 RUCKER AVE 1ST FLOOR 2023-02-06

in MECHANICAL PERMIT APPLICADION 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3927 RUCKER AVE PARCEL#: 00411300501300 CITY EVERETT STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: THE EVERETT CLINIC OWNER MAILING ADDRESS: STREET 3901 HOYT AVE CITY EVERETT STATE WA ZIP 98201 OWNER PHONE: OWNER EMAIL:Rajesh.Kumar@uhg.com CONTRACTOR COMPANY NAME:MACDONALD MILLER FACILITY SOLUTIONS WA STATE CONTRACTOR LICENSE#(REQUIRED):MACDOFS808OS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 040665 CONTRACTOR ADDRESS: STREET 7717 DETROIT AVE SW CITY SEATTLE STATE WA ZIP 98106 CONTRACTOR PHONE:206-763-9400 CONTRACTOR EMAIL:Permits@macmiller.com PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME:AMANDA MOORE CONTACT PHONE:206-867-4133 CONTACT EMAIL:permits@macmiller.com MECHANICAL PERMIT INFORMATION VALUATION OF WORK: $30000 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: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK:DEMO AND INSTALL NEW EXHAUST FAN AND ASSOCIATED DUCTWORK. RLOCATE (2) RETURN GRILLES AND ADD FLEX DUCT TO CONNECT RETURN GRILLES. WI, It 1^tviJ MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) £44J,t/ IViIOW, Fixture Fixture 11 Count List of Fixtures Count List of Fixtures %I''1 �l% (QtY) (Qty) l 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) Compressors/Generators(building permit may be required)** Heat Pump Ductless(attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronic Piping 1 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*** Other(List Type): Exhaust Hood Type II*** Other(List Type): Furnace(residential) Other(List Type): * 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 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# c; �� c� Seattle,wA 7/11/2022 Yr 2 I 22.07.11 13:38:49-0T00' D Owner/Authorized Agent Signature Date (Revised 4/21/2022) 1 ) /Z