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MEliANICAL PERMIT APPLICIOIC EcEuvEm <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application &plan to 3 Cedar Street 2nd Floor Intake it b Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1 (E)PermitServices@everettwa. t"1 (W)MARtt4a0o2,prnits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 900 PACIFIC AVENUE PARCEL#: 2905Q 30. <br /> r �, roi�,�f'VICG? <br /> crry EVERETT STATE WA ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: Basement& Roof ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME (if non-residential):PROVIDENCE REGIONAL MEDICAL CENTER <br /> CONTACT INFORMATION <br /> OWNER NAME: PROVIDENCE HEALTH & SERVICES WASHINGTON <br /> OWNER MAILING ADDRESS: STREET 1801 LIND AVE SW#9016 <br /> crry RENTON STATE WA ZIP 98057 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:MACDONALD MILLER FACILITY SOLUTIONS <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):MACDOFS808OS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 040665 <br /> CONTRACTOR ADDRESS: STREET 17930 INTERNATIONAL BLVD, SUITE 120 <br /> crnr SEATAC STATE WA zip 98188 <br /> CONTRACTOR PHONE:206-763-9400 CONTRACTOR EMAIL:Permits@macmiller.com <br /> PRIMARY CONTACT: [_ ..I OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-867-4133 <br /> AMANDA MOORE <br /> CONTACT EMAIL:permits@macmiller.com <br /> MECHANICAL PERMIT INFORMATION <br /> VALUATION OF WORK: $30,000 ASSOCIATED PERMIT#(if applicable): <br /> (Valuation sha I Inc ude the prevailing fair market value of all labor,materials.and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse I:.Duplex PADU ❑Multi-Family-#Units: I✓1Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: Installing of split systems for two separate elevator banks. (2)indoor units to be installed serving basement level elevator rooms <br /> and (2)outdoor units installed in the parking garage. (2)indoor units installed in the level 7 elevator penthouse and(1)outdoor unit <br /> installed on the level 7 roof. <br /> MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (QtY) (QtY) <br /> NC Unit(attach plan with location of outdoor unit) Gas Piping-List#of outlets in fixture count <br /> Air Handling Unit** Gas Appliance** <br /> Boiler(most require backflow prevention)** Gas Fireplace,Insert,and/or Log(*for commercial bldgs) <br /> Commercial Refrigeration(Walk-in coolers,VRF,VRv,etc.) Gas-Other(List Type): ** <br /> Commercial Ventilation(corridors,stairwell,pressurization,etc.) Heat Pump(attach plan with location of outdoor unit) <br /> Compressors/Generators(building permit may be required)** 1 Heat Pump Ductless(attach plan with location of outdoor unit) <br /> Clothes Dryer Exhaust Hydronic Piping <br /> Duct System(additions,alterations) Unit heater(commercial use) <br /> Exhaust Fan(residential or commercial use) Water Heater(gas or electric) <br /> Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert <br /> Exhaust Hood Type I *** 2 Other(List Type):nl ITDnOR CONIIFNSING UNITS <br /> Exhaust Hood Type II *** 4 Other(List Type): INDOOR FAN COIL UNITS <br /> Furnace(residential) Other(List Type): <br /> * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. <br /> ** Under Description of Work,please include Type of Equipment,model#'s,ad detailed description of work,and the location of the equipment. <br /> 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 <br /> *** described in the associated Checklists online at everettwa.gov/permits under the Checklists&Handouts tab. <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 3/3/2023 PERMIT# r �_ 0 <br /> Seattle,WA i; .� / ) <br /> ;. 423.03.03 16:22:30-06'00' 4' V <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />