1330 ROCKEFELLER AVE MEDICAL OFFICE BLDG 1ST FLOOR 2019-12-26

PERMIT APPLICATIaiI BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION EVERETTCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1330 Rockefeller Avenue PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health & Services TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 105 W. 8th Avenue, Suite 7040 cITM Spokane STATE WA ZIP 98204 OWNER PHONE: OWNER EMAIL: JameS.Grafton@providence.org CONTRACTOR NAME: Providence Regional Medical Center Everett CONTRACTOR ADDRESS: STREET 1321 Colby Avenue cm, Everett STATE WA ZIP 98201 CONTRACTOR PHONE: 425-261-3746 CONTRACTOR EMAIL: Peter.Smeltz@providence.org providence.org CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR El OTHER(Please Specify)Architect CONTACT NAME: CONTACT PHONE: 425-259-0861 Devin Saylor, AIA CONTACT EMAIL: devin@bn c om1 BUILDING INFORMATION Existing Use of Building: Medical Office Building Clinic Contract Price of Wo :$ 35,000.00 Proposed Use of Building: Medical Office Building Clinic Heat Source: OG.•s ❑Electri ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 0 ommercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Interior Tenant Improvement remodel of an existing 1,458 SF outpatient medical clinic on the First Floor (Suite 140)of the existing Medical Office Building. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration ,Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT 8-5-2019 Owner/Authorized A I nt Signa ure Date (Revised 10/10/2018) 'I1,