12800 19TH AVE SE 2021-02-23 - Laserfiche WebLink

• PERMIT APPLICATION • BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Ploaae) 4.1w PROJECT SITE INFORMATION PROJECT SITE ADDRESS:12800 t3ottieU veEett wy$ Everett,WA 98208 PROPERTY TAX#:See Attached LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health and Services-Washington TENANT BUSINESS NAME(Commercial): WWMG Endoscopy OWNER MAILING ADDRESS: STREET 105 W 8th Ave., Suite 7040 clr' Spokane STATE WA zip 99204 DyyNER PHpge 425-261-4563 OWNER EMAILs,james.grafton@providence.org CONTRACTOR NAME:,Providence Facilities Department CONTRACTOR ADDRESS:, STREET 1321 Colby Ave CITY Everett STATE WA zip 98201 CONTRACTOR PHONE i425-261-3746 CONTRACTOR EMAIL:Peter.smeltz@providence.org CONTRACTOR LICENSE#(REQUIRED):. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):: 47317 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR O OTHER(Please Specify) ARCHITECT CONTACT NAME: CONTACT PHONE:206-962-9373 Kristopher Herrell CONTACT EMAIL:kherrell@tgbarchitects.com BUILDING INFORMATION Existing Use of Building:Medical Office Building-Business Contract Price of Work:$5,000 Proposed Use of Building:No Change of Use Heat Source: ❑Gas SElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Construct wall and door to create exit enclosure from suite to existing stair enclosure. 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/InserULog 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# 0 19 S•Z32rn1 d ne u ed A nature Date (Revised 10/10/2018) q2M-7)