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IPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> 1700 13TH ST EVERETT, WA 98201 00438524702102 MIS-10 - <br /> LEGAL for new construction: Short Plat/subdivision SEE PLANS Lot No.N/A (attach copy of long legal description) <br /> OWNER PROVIDENCE MEDICAL CENTER Phone/E-mail N/A <br /> Address 1700 13TH ST City/State/Zip EVERETT, WA 98201 <br /> APPLICANT: Owner Owner's Agent X Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR MACDONALD MILLER L& I Lic.# MACDOFS980RU COE Bus. Lic.#040665 <br /> Address 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone/Email (206) 768-4278 darla.doll@macmiller.com <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PROVIDENCE - EVERETT LOGAN ORDONA <br /> Phone/E-mail (206) 768-4012/ logan.ordona@macmiller.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $59,000.00 <br /> Existing Use of Building COMMERICAL/ HOSPITAL HEAT SOURCE: <br /> Proposed Use of Building NO CHANGE Gas Electric X Other <br /> Building type: Single Family Duplex Townhouse Multi-Family X Commercial <br /> Type of project: New Addition Remodel X Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Install (1) Fan Coil Unit Misc piping per plans. Misc Piping per plans and relocate approx. (2) Diffusers. Misc ductwork. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn X Alteration_Repair Type of Project: New Addn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> 1 Other FAN COIL UNIT Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads 1 Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.Ad provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That 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. <br /> 10/22/2015 <br /> Owner/Authorized Agent Signature Date (Revisked 6/2012) <br />