If the design was changed to use the MV on each floor then the electric rooms will be much larger than with the 480 volt system.

I doubt that it would save cost. The MV cable and equipment cost more than the 480 and will require more room that will cut into the available sq/ft for lease.

You will still need a MV switch for the POCO somewhere, most likely outside.

I don't think you will save much from the POCO.