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tRMIT APPLICATIOF <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 /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> 2930 MAPLE ST EVERETT,WA 98201 00439069505800 ' (C —/6 s <br /> LEGAL for new construction: Short PlaUsubdivisior ever0U land co s let add blk 695 d-001 ot No. 59 (attach copy of long legal description) <br /> OWNER GROUP HEALTH Phone/E-mail <br /> Address 2930 MAPLE 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 State Lic.# MACDOFS980RU City Bus. Lic.# 040665 <br /> Address 7717 DETROIT AVE SW SEATTLE,WA 98106 Phone/Email (206)768-4278 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> GROUP HEALTH- EVERETT LOGAN ORDONA <br /> Phone/E-mail (206)768-4012/Logan.ordona@macmiller.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $1,500.00 <br /> Existing Use of Building MEDICAL OFFICE HEAT SOURCE: <br /> Proposed Use of Building NO CHANGE Gas_ Electric! Other <br /> Building type: Single Family Duplex Townhouse Multi-Family X Commercial <br /> Type of project: New Addition Remodel Repair X T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> INSTALL PIPING FOR SCOPE WASHER AND INSTALL(2) BACKFLOW PREVENTERS. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration_Repair Type of Project: X New_Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—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 2 Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM 2 Other: SCOPE WASHER <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <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 1 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 /> 7/10/2015 <br /> OwnerTAuthorized Agent Signature Date (Revised 9/2014) <br />