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PERMIT APPLICATIOt <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1321 Colby Ave Everett,WA 98201 PROPERTY TAX#: 00438524600000 <br /> LEGAL for new construction: Short Plat/subdivision_div"R"Blk 246 D-00 Blks 646 Lot No. 1 -32 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PRMCE TENANT NAME(If Commercial): Providence Medical Center <br /> OWNER MAILING ADDRESS: STREET 1321 Colby Ave <br /> cT Everett STATE WA zip 98201 <br /> OWNER PHONE: N/A OWNER EMAIL: N/A <br /> CONTRACTOR NAME: MacDonald Miller <br /> CONTRACTOR ADDRESS: STREET 7717 Detroit Ave SW <br /> CITY Seattle STATE WA zip 98106 <br /> CONTRACTOR PHONE: (206) 768-4278 CONTRACTOR EMAIL: darla.doll@macmiller.com <br /> CONTRACTOR LICENSE#(REQUIRED): MACDOFS980RU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 040665 <br /> PRIMARY CONTACT: ❑ OWNER ®CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: DARLA DOLL CONTACT PHONE: (206) 768-4278 <br /> CONTACT EMAIL: darla.doll@macmiller.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: MEDICAL CENTER Contract Price of Work:$ 210,000.00 <br /> Proposed Use of Building: MEDICAL CENTER Heat Source: ❑Gas IA_=lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ®_Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair XT.l. []Sign []Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> Demo (1) 300-ton Chiller and associated Piping. Install (1) 300-ton Chiller on grade level. Install new Refer piping and <br /> Replace (3) existing Flex Pipe Connections with new. <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _x Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups 1 Other: CHILLER Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 /> City of Everett Official Use Only <br /> PERMIT# + (� <br /> 1/15/2016 a�� <br /> O l <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> 1 I .Z <br />