1321 COLBY AVE 2ND FLOOR 2022-01-26

PERMIT APPLICATIO10 EVERETT WASH:INGTON BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits Blue or Black Ink Only Ploaso) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:1321 Colby Avenue L V\Cp E T #: LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Health & Systems TENANT BUSINESS NAME (Commercial): OWNER MAILING ADDRESS: STREET 105 W. 8th Avenue, Suite 7040 crry Spokane STATE WA zip 98204 OWNER PHONE: OWNER EMAIL: James.Grafton@providence.org CONTRACTOR NAME: P €diem-CL�r Cx_"0_r_Q' CONTRACTOR ADDRESS: STREET 1321 Colby Avenue cITr Everett STATE WA zia 98201 CONTRACTOR PHONE: CONTRACTOR EMAIL: Christopher.Diseth@providence.org CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR I] OTHER (Please Specify) Architect CONTACT NAME: Devin Saylor, AIA CONTACT PHONE: 425-259-0868 CONTACT EMAIL: devin@bnharch.com BUILDING INFORMATION �Z Existing Use of Building: Hospital 1-2 lContract Price of Work: Proposed Use of Building: Hospital 1-2 Heat Source: lZIGas ❑Electric []Other BUILDING USE: ❑SFR ❑Townhouse ❑Du lex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ORemodel ❑Repair RIT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan a of Use DESCRIPTION OF WORK: ToRent4ffiprovemieRt+eniedei-pTuieL-Fm an existing vacated Spaug ece ASSOCIATED BUILDING PERMIT # (if applicable): `` �' —` o�_ T v MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List of Fixtures Fixture count Ust of Fixtures Fixture Count List of Fixtures Fixture 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 Ventilatior (Not Heat/AC system) Floor Drain Toilet Exhaust Hood (Type 1) 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 I 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 3-5-20 Is Owner/Authorized Agent Signature Date (Revised 1011012018) 1,77-