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PERMIT APPLICATIO' <br />BUILDIW> , MECHANICAL / PLUMBING / SIGN. jPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 i FAX 425-257-8857 i (E) everetteps@everettwa.gov i www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 2930 MAPLE ST, EVERETT, WA 98201 <br />PROPERTY TAX #: 00439069505800 <br />LEGAL for new construction: Short Piat/subdivision SEE ATTACHMENT Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: KAISER PERMANENTE HEALTH PLAN OF WA - EVERETT TENANT NAME (If Commercial): KP EVM BREAKROOM <br />OWNER MAILING ADDRESS: STREET 6115 CAMP BOWIE BLVD STE 152 <br />crry FORT WORTH STATE TX Zip 76116 <br />OWNER PHONE: N/A <br />OWNER EMAIL: N/A <br />CONTRACTOR NAME: MACDONALD MILLER FACILITY SOLUTIONS <br />CONTRACTOR ADDRESS: STREET 7717 DETROIT AVE SW <br />aTv SEATTLE STATE WA zip 98106 <br />CONTRACTOR PHONE: (206) 768-4062 <br />CONTRACTOR EMAIL: permits@macmiller.com <br />CONTRACTOR LICENSE #(REQUIRED): MACDOFS980RU <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 040665 <br />PRIMARY CONTACT: ❑ OWNER ;?CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />AMMONE BEMBRY <br />CONTACT PHONE: (206) 768-4062 <br />CONTACT EMAIL: permits@macmiller.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: MEDICAL CENTER <br />Contract Price of Work: $ 1,200 <br />Proposed Use of Building: MEDICAL CENTER <br />I Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex []Multi -Family-# of Units: I Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair 0T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />Demo old sink & faucet & install new faucet in new countertop with intergraded sink at same location, per plan. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration <br />_Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />itchen-Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />1 <br />Other: Faucet <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />No. of Heads <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />02/20/2020 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />1P T � D I0� <br />(Revised 9,,23/2016) <br />