BLD2021-1583+Application+11.21.2021_12.02.23_PM+2531705RECEIVED BLD2021-1583
Nov 21 2021 de,
CITY OF EDMONDS CITY OF EDMONDS MyBuildingPermit.com
J DEVELOPMENT SERVICES
DEPARTMENT
Plumbing Application #1053275 - SMC Edmonds Surgery Center TI
Applicant
First Name Last Name Company Name
Ammone Berl MacDonald Miller Facility Solutions
Number Street Apartment or Suite Number E-mail Address
7717 Detroit Ave SW permitsl_L_macmiller.com
City State Zip Phone Number Extension
Seattle WA 98106 2067684062
Contractor
Company Name
MACDONALD MILLER FAC SOL INC
Number Street Apartment or Suite Number
7717 Detroit Ave SW
City State Zip Phone Number Extension
Seattle WA 98106 (206) 768-4062
State License Number License Expiration Date UBI # E-mail Address
MACDOFS798P9 10/25/2023 602254260 permits(c�macmiller.com
Project Location
Number Street Floor Number Suite or Room Number
21601 76TH AVE W 1 None
City Zip Code County Parcel Number
EDMONDS 98026 00580700002500
Associated Building Permit Number Tenant Name
SMC Edmonds Surgery Center TI
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name Last Name or Company Name
PUBLIC HOSPITAL DISTRICT 2 SNOHOMISH CO
Number Street Apartment or Suite Number
4710 196TH ST SW
City State Zip
LYNNWOOD WA 98036-5517
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 11/21/2021 Submitted By: Ammone Bembry
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CITY OF EDMONDS MYBuildingPerrnit.com
Plumbing Application #1053275 - SMC Edmonds Surgery Center TI
Project Contact
Company Name: MacDonald Miller Facility
Solutions
Name: Ammone Bembry Email: permits@macmiller.com
Address: 7717 Detroit Ave SW Phone #: 2067684062
Seattle WA 98106
Project Type
Nonresidential
Activity Type
Alteration
Project Name: SMC Edmonds Surgery Center TI
Scope of Work
Plumbing
DEMO CEILING MOUNTED 02 (2), VAC (1) AND N20 (1) OUTLETS AND ASSOCIATED
Description of PIPING. INSTALL NEW WALL MOUNTED 02 (2), VAC (5), N20 (1) AND WAGD (1)
Work: OUTLETS AND ASSOCIATED PIPING. PROVIDE MEDICAL GASIVACUUM SYSTEM
TESTING & CERTIFICATION IN ACCORDANCE WITH NFPA 99, PER PLAN ON FLOOR 1
Project Details
Type of Use
Work includes commercial kitchen, food svc, med
gas, lab, medical use, or dental use.
Additional Project Information
Total number of fixtures being added or altered
Work Location
Work Description/Location (example: 1st floor,
Master Bath, Garage)
9
DEMO CEILING MOUNTED 02 (2), VAC (1) AND N20
(1) OUTLETS AND ASSOCIATED PIPING. INSTALL
NEW WALL MOUNTED 02 (2), VAC (5), N20 (1) AND
WAGD (1) OUTLETS AND ASSOCIATED PIPING.
PROVIDE MEDICAL GAS/VACUUM SYSTEM
TESTING & CERTIFICATION IN ACCORDANCE WITH
NFPA 99, PER PLAN ON FLOOR 1.
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