1321 COLBY AVE 2ND FLOOR 2021-02-17

1111.1 PERMIT APPLICATION 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:`fQ9^ Y C9 V3)\ Q.so\Nak\A-02._ PROPERTY TAX#:00438524702102 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health&Services Washington TENANT BUSINESS NAME(CommercialMMadt ` OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW#9016 �� . C fkr�� V3 Q cin. Renton STA E WA zip 98057 OWNER PHONE: OWNER EMAIL: bk9.0 S - 02 CONTRACTOR NAME:PSF Mechanical, Inc. CONTRACTOR ADDRESS: STREET 11621 E Marginal Way S,Suite A cm,' Seattle STATE WA zip 98166 CONTRACTOR PHONE:206-764-9663 CONTRACTOR EMAIL:Permits@psfmech.com CONTRACTOR LICENSE#(REQUIRED):PSFMEI`090NZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 026337 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-812-7683 Amanda Moore CONTACT EMAIL:permits@psfmech.com BUILDING INFORMATION Existing Use of Building:Commercial Contract Price of Work:$ IJ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair [DTI. ❑Sign ❑Sprinkler EDemolition ❑Change of Use DESCRIPTION OF WORK: Install plumbing fixtures. 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 4 Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration 1 Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior 1 Floor Drain 1 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 I 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 / PE \, �� -- 01 d , 7/29/2019 er Authorized •gent Signature Date (Revised 10/10/2018)